# Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-Fourth Quarter, 1999 through First Quarter, 2002 > Briefs, arguments, decisions, and more. URL: https://www.frixlaw.com/law-library/documents/fr%3A02-16147 ## Record - **Collection:** Federal Register - **Document type:** Notice - **Published:** June 28, 2002 - **Citation:** 67 FR 43762 ## Text DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-9880-N] Medicare and Medicaid Programs; Quarterly Listing of Program Issuances—Fourth Quarter, 1999 through First Quarter, 2002 AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice. SUMMARY: This notice lists CMS manual instructions, substantive and interpretive regulations, and other Federal Register notices that were published from October 1999, through March 2002, relating to the Medicare and Medicaid programs. This notice also identifies certain devices with investigational device exemption numbers approved by the Food and Drug Administration that potentially may be covered under Medicare, and provides information on national coverage determinations affecting specific medical and health care services under Medicare. Section 1871(c) of the Social Security Act requires that we publish a list of Medicare issuances in the Federal Register at least every 3 months. Although we are not mandated to do so by statute, for the sake of completeness of the listing, we are also including all Medicaid issuances and Medicare and Medicaid substantive and interpretive regulations (proposed and final) published during this timeframe. FOR FURTHER INFORMATION CONTACT: It is possible that an interested party may have a specific information need and not be able to determine from the listed information whether the issuance or regulation would fulfill that need. Consequently, we are providing information contact persons to answer general questions concerning these items. Copies are not available through the contact persons. Questions concerning Medicare items in Addendum III may be addressed to Karen Bowman, Office of Communications and Operations Support, Division of Regulations and Issuances, Centers for Medicare & Medicaid Services, C5-13-27, 7500 Security Boulevard, Baltimore, MD 21244-1850, (410) 786-5252. Questions concerning Medicaid items in Addendum III may be addressed to Cindy Potter, Center for Medicaid State Operations, Policy Coordination and Planning Group, Centers for Medicare & Medicaid Services, S2-01-01, 7500 Security Boulevard, Baltimore, MD 21244-1850, (410) 786-6714. Questions concerning Food and Drug Administration-approved investigational device exemptions may be addressed to Sharon Hippler, Office of Clinical Standards and Quality, Coverage and Analysis Group, Centers for Medicare & Medicaid Services, C4-11-04, 7500 Security Boulevard, Baltimore, MD 21244-1850, (410) 786-4633. Questions concerning national coverage determinations should be directed to Kimberly Long, Office of Clinical Standards and Quality, Coverage and Analysis Group, Centers for Medicare & Medicaid Services, S3-11-15, 7500 Security Boulevard, Baltimore, MD 21244-1850, (410) 786-5702. Questions concerning all other information may be addressed to Christopher McClintick, Office of Communications and Operations Support, Division of Regulations and Issuances, Centers for Medicare & Medicaid Services, C5-13-15, 7500 Security Boulevard, Baltimore, MD 21244-1850, (410) 786-4682. SUPPLEMENTARY INFORMATION: I. Program Issuances The Centers for Medicare & Medicaid Services (CMS) is responsible for administering the Medicare and Medicaid programs. These programs pay for health care and related services for 39 million Medicare beneficiaries and 35 million Medicaid recipients. Administration of these programs involves (1) furnishing information to Medicare beneficiaries and Medicaid recipients, health care providers, and the public and (2) maintaining effective communications with regional offices, State governments, State Medicaid agencies, State survey agencies, various providers of health care, fiscal intermediaries and carriers that process claims and pay bills, and others. To implement the various statutes on which the programs are based, we issue regulations under the authority granted to the Secretary of the Department of Health and Human Services under sections 1102, 1871, 1902, and related provisions of the Social Security Act (the Act). We also issue various manuals, memoranda, and statements necessary to administer the programs efficiently. Section 1871(c)(1) of the Act requires that we publish a list of all Medicare manual instructions, interpretive rules, statements of policy, and guidelines of general applicability not issued as regulations at least every 3 months in the Federal Register . We published our first notice June 9, 1988 (53 FR 21730). Although we are not mandated to do so by statute, for the sake of completeness of the listing of operational and policy statements, we are continuing our practice of including Medicare substantive and interpretive regulations (proposed and final) published during the 3-month time frame. II. How To Use the Addenda This notice is organized so that a reader may review the subjects of manual issuances, memoranda, substantive and interpretive regulations, and Food and Drug Administration-approved investigational device exemptions, and national coverage determinations published during the timeframe to determine whether any are of particular interest. We expect this notice to be used in concert with previously published notices. Those unfamiliar with a description of our Medicare manuals may wish to review Table I of our first three notices (53 FR 21730, 53 FR 36891, and 53 FR 50577) published in 1988, and the notice published March 31, 1993 (58 FR 16837). Those desiring information on the Medicare Coverage Issues Manual may wish to review the August 21, 1989 publication (54 FR 34555). Those interested in the procedures used in making national coverage determinations may review the April 27, 1999 publication (64 FR 22619). In this publication, the 1989 proposed rule affecting national coverage procedures and decisions (54 FR 4302) was withdrawn, and the procedures for national coverage determinations established. To aid the reader, we have organized and divided this current listing into six addenda: • Addendum I lists the publication dates of the most recent quarterly listings of program issuances. • Addendum II identifies previous Federal Register documents that contain a description of all previously published CMS Medicare and Medicaid manuals and memoranda. • Addendum III lists a unique CMS transmittal number for each instruction in our manuals or Program Memoranda and its subject matter. A transmittal may consist of a single instruction or many. Often, it is necessary to use information in a transmittal in conjunction with information currently in the manuals. • Addendum IV lists all substantive and interpretive Medicare and Medicaid regulations and general notices published in the Federal Register during the quarters covered by this notice. For each item we list the— • Date published; • Federal Register citation; • Parts of the Code of Federal Regulations (CFR) that have changed (if applicable); • Agency file code number; • Title of the regulation; • Ending date of the comment period (if applicable); and • Effective date (if applicable). • Addendum V includes listings of the Food and Drug Administration-approved investigational device exemption numbers that have been approved or revised during the quarters covered by this notice. On September 19, 1995, we published a final rule (60 FR 48417) establishing in regulations at 42 CFR 405.201 et seq. that certain devices with an investigational device exemption approved by the Food and Drug Administration and certain services related to those devices may be covered under Medicare. It is our practice to announce all investigational device exemption categorizations, using the investigational device exemption numbers the Food and Drug Administration assigns. The listings are organized according to the categories to which the device numbers are assigned (that is, Category A or Category B, and identified by the investigational device exemption number). • Addendum VI includes completed national coverage determinations from June 28, 1999, the effective date of Medicare's new coverage process. Completed decisions are identified by title, a brief description, effective date, and section in the appropriate federal publication. III. How To Obtain Listed Material A. Manuals Those wishing to subscribe to program manuals should contact either the Government Printing Office (GPO) or the National Technical Information Service (NTIS) at the following addresses: Superintendent of Documents, Government Printing Office, ATTN: New Orders, P.O. Box 371954, Pittsburgh, PA 15250-7954, Telephone (202) 512-1800, Fax number (202) 512-2250 (for credit card orders); or National Technical Information Service, Department of Commerce, 5825 Port Royal Road, Springfield, VA 22161, Telephone (703) 487-4630. In addition, individual manual transmittals and Program Memoranda listed in this notice can be purchased from NTIS. Interested parties should identify the transmittal(s) they want. GPO or NTIS can give complete details on how to obtain the publications they sell. Additionally, most manuals are available at the following Internet address: http://www.hcfa.gov/pubforms/progman.htm. B. Regulations and Notices Regulations and notices are published in the daily Federal Register . Interested individuals may purchase individual copies or subscribe to the Federal Register by contacting the GPO at the address given above. When ordering individual copies, it is necessary to cite either the date of publication or the volume number and page number. The Federal Register is also available on 24x microfiche and as an online database through GPO Access. The online database is updated by 6 a.m. each day the Federal Register is published. The database includes both text and graphics from Volume 59, Number 1 (January 2, 1994) forward. Free public access is available on a Wide Area Information Server (WAIS) through the Internet and via asynchronous dial-in. Internet users can access the database by using the World Wide Web; the Superintendent of Documents home page address is http://www.access.gpo.gov/nara/index.html, by using local WAIS client software, or by telnet to swais.access.gpo.gov, then log in as guest (no password required). Dial-in users should use communications software and modem to call (202) 512-1661; type swais, then log in as guest (no password required). C. Rulings We publish rulings on an infrequent basis. Interested individuals can obtain copies from the nearest CMS Regional Office or review them at the nearest regional depository library. We have, on occasion, published rulings in the Federal Register . Rulings, beginning with those released in 1995, are available online, through the CMS Home Page. The Internet address is http://www.hcfa.gov/regs/rulings.htm. D. CMS's Compact Disk-Read Only Memory (CD-ROM) Our laws, regulations, and manuals are also available on CD-ROM and may be purchased from GPO or NTIS on a subscription or single copy basis. The Superintendent of Documents list ID is HCLRM, and the stock number is 717-139-00000-3. The following material is on the CD-ROM disk: • Titles XI, XVIII, and XIX of the Act. • CMS-related regulations. • CMS manuals and monthly revisions. • CMS program memoranda. The titles of the Compilation of the Social Security Laws are current as of January 1, 1999. (Updated titles of the Social Security Laws are available on the Internet at http://www.ssa.gov/OP_Home/ssact/comp-toc.htm. ) The remaining portions of CD-ROM are updated on a monthly basis. Because of complaints about the unreadability of the Appendices (Interpretive Guidelines) in the State Operations Manual (SOM), as of March 1995, we deleted these appendices from CD-ROM. We intend to re-visit this issue in the near future and, with the aid of newer technology, we may again be able to include the appendices on CD-ROM. Any cost report forms incorporated in the manuals are included on the CD-ROM disk as LOTUS files. LOTUS software is needed to view the reports once the files have been copied to a personal computer disk. IV. How To Review Listed Material Transmittals or Program Memoranda can be reviewed at a local Federal Depository Library (FDL). Under the FDL program, government publications are sent to approximately 1,400 designated libraries throughout the United States. Some FDLs may have arrangements to transfer material to a local library not designated as an FDL. Contact any library to locate the nearest FDL. In addition, individuals may contact regional depository libraries that receive and retain at least one copy of most Federal Government publications, either in printed or microfilm form, for use by the general public. These libraries provide reference services and interlibrary loans; however, they are not sales outlets. Individuals may obtain information about the location of the nearest regional depository library from any library. Superintendent of Documents numbers for each CMS publication are shown in Addendum III, along with the CMS publication and transmittal numbers. To help FDLs locate the materials, use the Superintendent of Documents number, plus the transmittal number. For example, to find the Intermediary Manual, Part 3—Claims Process, (HCFA Pub. 13-3) transmittal entitled “Mammography Screening,” use the Superintendent of Documents No. HE 22.8/6 and the transmittal number 1782. (Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance, Program No. 93.774, Medicare—Supplementary Medical Insurance Program, and Program No. 93.714, Medical Assistance Program) Dated: June 20, 2002. Jacquelyn Y. White, Director, Office of Communications and Operations Support. Addendum I This addendum lists the publication dates of the most recent quarterly listings of program issuances. June 4, 1998 (63 FR 30499) August 11, 1998 (63 FR 42857) September 16, 1998 (63 FR 49598) December 9, 1998 (63 FR 67899) May 11, 1999 (64 FR 25351) November 2, 1999 (64 FR 59185) December 7, 1999 (64 FR 68357) January 10, 2000 (65 FR 1400) May 30, 2000 (65 FR 34481) Addendum II—Description of Manuals, Memoranda, and HCFA Rulings An extensive descriptive listing of Medicare manuals and memoranda was published on June 9, 1988, at 53 FR 21730 and supplemented on September 22, 1988, at 53 FR 36891 and December 16, 1988, at 53 FR 50577. Also, a complete description of the Medicare Coverage Issues Manual was published on August 21, 1989, at 54 FR 34555. (Please note that in this publication the 1989 proposed rule referred to, concerning the criteria for national coverage determinations, was withdrawn (64 FR 22619)). A brief description of the various Medicaid manuals and memoranda that we maintain was published on October 16, 1992 (57 FR 47468). Addendum III.—Medicare and Medicaid Manual Instructions Transmittal No. Manual/Subject/Publication No. October 1999 through December 1999 Intermediary Manual Part 3—Claims Process (HCFA Pub. 13-3) (Superintendent of Documents No. HE 22.8/6) 1782 • Mammography Screening 1783 • Clarification of Reimbursement for Transfers That Result in Same Day Hospice Discharge and Admission 1784 • Bill Review for Partial Hospitalization Services Provided in Community Mental Health Centers 1785 • Payment Calculation for Outpatient Claims Medicare Secondary Payment Modules 1786 • Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines 1787 • Review of Form HCFA—1450 for Inpatient and Outpatient Bills Inpatient Part B Services Outpatient Services Calculating the Part B Payment HCFA Common Procedure Coding System Addition, Deletion, and Change of Local Codes Reporting Hospital Outpatient Services Using HCFA Common Procedure Coding System Hospital Outpatient Partial Hospitalization Services Carriers Manual Part 3—Claims Process (HCFA Pub. 14-3) (Superintendent of Documents No. HE 22.8/7) 1650 • Services Eligible for HPSA Bonus Payments Post-Payment Review 1651 • Identifying a Screening Mammography Claim 1652 • Medicare Physician Fee Schedule Database 2000 File Layout 1653 • Type of Service 1654 • Cryosurgery of the Prostate Gland 1655 • HCFA Common Procedure Coding System 1656 • Coverage of Chiropractic Services 1657 • Review of the Health Insurance Claim Form—HCFA-1500, Item 24 Program Memorandum Intermediaries (HCFA Pub. 60A) (Superintendent of Documents No. HE 22.8/6-5) A-99-43 • File Descriptions and Instructions for Retrieving the 2000 Physician, Clinical Lab, Durable Medical Equipment, Prosthetics/Orthotics and Supplies Fee Schedule Payment Amounts through HCFA's Mainframe Telecommunications Systems A-99-44 • Discharges to Swing Bed Units and other Post-Acute Care Providers A-99-45 • Requirements for Billing and Processing Claims for Services Subject to Line Item Data of Service Reporting A-99-46 • Implementation and Corrections to the Federal Register Notice Published August 5, 1999 for Home Health Agency Cost Limitation Effective October 1, 1999 A-99-47 • Extended Repayment Schedules for Home Health Agencies Affected by the Interim Payment System A-99-48 • Renewal of Program Memorandum A-97-8—Instructions to Implement the New Medicare Summary Notice Combined with Program Memorandum AB-98-31 A-99-49 • Proper Reporting and Acceptance of Non-covered Changes and Related Revenue Codes A-99-50 • Policy Clarification: Coding for Adequacy of Hemodialysis A-99-51 • FY 2000 Prospective Payment System Tax, Equity, and Fiscal Responsibility Act Hospital, and Other Bill Processing Changes A-99-52 • Home Health Agency Instructions for the Provision of Advance Beneficiary Notices And for Mandatory Claims Submission (Demand Bills) A-99-53 • Skilled Nursing Facility Election of Immediate Transition to 100% Federal Rate and Special Rules for Certain Skilled Nursing Facilities A-99-54 • Advance Beneficiary Notices Must Be Given To Beneficiaries and Demand Bills Must Be Submitted Promptly By Home Health Agencies A-99-55 • HAS BEEN RESCINDED AND WILL NOT BE RELEASED A-99-56 • Reopenings for Sole Community Hospital and Medicare Dependent Hospital Cost Reports Due to the Change to the Cost Report Instructions in Calculating the Hospital Specific Amount on Form HCFA-2552-96 and Form HCFA-2552-92 A-99-57 • Hospital Outpatient Procedures: Billing for Contrast Material (Clarification) A-99-58 • Hospital Outpatient Procedures: Medicare Changes for Radiology and Other Diagnostic Coding Due to the 1999 HCFA Common Procedure Coding System Update; Revised Modifiers A-99-59 • New Composite Payment Rates Effective January 1, 2000, and Reopening of the Exception Process Under the End Stage Renal Disease Composite Rate System A-99-60 • Implementation of H.R. 3426, the Medicare, Medicaid, and the State Child Health Insurance Program Balanced Budget Refinement Act of 1999, P.L. 106-113, Section 303 (a) Which Revises the Per-Beneficiary Limitations on Home Health Agency Costs for Certain Home Health Agencies A-99-61 • Special Adjustment for Federal Skilled Nursing Facility Prospective Payment Rates and Special Payment Rules Applicable to Certain Skilled Nursing Facilities A-99-62 • Clarification of Allowable Medicaid Days in the Medicare Disproportionate Share Hospital Adjustment Calculation Program Memorandum Carriers (HCFA Pub. 60B) (Superintendent of Documents No. HE 22.8/6-5) B-99-35 • Enrollment of Independent Diagnostic Testing Facilities B-99-36 • Schedule for Completing the Calendar Year 2000 Update and Enrollment Process for the Medicare Physician Fee Schedule Database B-99-37 • Calendar Year 2000 Participation Enrollment and Medicare Participating Physicians and Suppliers Directory Procedures B-99-38 • Addition of Current Procedural Terminology Code 00300 to Use with G8 Monitored Anesthesia Care Modifier B-99-39 • Corrections to Calendar Year 2000 Medicare Physician Fee Schedule Database and Year 2000 Fact Sheet B-99-40 • Delay of Change to Form HCFA-1500 Instructions for Processing Physician Claims in Global Payment Systems (Change Request #457) B-99-41 • Instructions to Implement the New Medicare Summary Notice Program Memorandum B-98-4 and AB-98-31 B-99-42 • Calculation of National Standard Format for Electronic Remittance Advice Amount Fields and Balancing of Data; and Clarification to Claim Field EAO 21 for Coordination of Benefits B-99-43 • Issues Related to Critical Care Policy B-99-44 • Medicare Enrollment of Physical Therapists in Private Practice and Occupational Therapists in Private Practice Effective on or after January 1, 1999 B-99-45 • Emergency Changes to the 2000 Medicare Physician Fee Schedule Database Program Memorandum Intermediaries/Carriers (HCFA Pub. 60A/B) (Superintendent of Documents No. HE 22.8/6-5) AB-99-72 • Instructions for Implementing and Updating 2000 Payment Amounts for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies AB-99-73 • 2000 Payment Limit for Ambulance Services AB-99-74 • Clarification to Medicare Carrier Manual § 2130 Prosthetic Devices and Coverage Issues Manual § 60-9 Durable Medical Equipment Reference List—Coverage Intermittent Catheterization AB-99-75 • Interim Instructions for Processing Claims for Factor VIIa (Coagulation Factor, Recombinant) AB-99-76 • Education of Medicare Providers on the Adoption of Standard Electronic Health Care Transaction Formats in the United States AB-99-77 • Implementation of Edits for Prostate Cancer Screening AB-99-78 • Notice of New Interest Rate for Medicare Overpayments and Underpayments AB-99-79 • Collection of Comprehensive Encounter Data for Long-Term Care Demonstrations (Social Health Maintenance Organization, EverCare), Dual Eligible Demonstrations and Department of Defense Subvention Demonstration AB-99-80 • Clinical Diagnostic Laboratory Organ or Disease Panel Codes Billing Procedures for January 2000 AB-99-81 • Calculation of Average Allowed Charges for Residual Items and Services Excluding Ambulance Services, Subject to the Reasonable Charge Payment Methodology AB-99-82 • Procedures for Reporting of Medicare Contractor NON -Medicare Secondary Payer Currently Not Collectible Debts AB-99-83 • Final Rule Revising and Updating Medicare Policies Concerning Ambulance Services AB-99-84 • Implementation of Calendar Year 2000 Clinical Diagnostic Laboratory Fee Schedule and Laboratory and Ambulance Costs Subject to Reasonable Charge Payment Methodology in 2000 AB-99-85 • Clinical Diagnostic Laboratory Organ or Disease Panel Codes Claims Processing Procedures for April 2000 AB-99-86 • Durable Medical Equipment Regional Carrier Operating Instructions for New National Coverage of the Continuous Subcutaneous Insulin Infusion Pump, Effective for Services Performed on or after April 1, 2000 AB-99-87 • Clarification of Medicare Coverage of Abortion Services Instruction AB-99-88 • Program Memorandum on Statements of Intent to File Claims for Claims Filing Periods That End on December 31, 1999 AB-99-89 • Start Date Options for Processing Year 2000 Services AB-99-90 • Clarification of Program Memorandum Transmittal No. AB-98-35 (Consolidated Billing for Skilled Nursing Facilities) and Revision to Transmittal No. AB-98-18 (Consolidated Billing for Skilled Nursing Facilities) AB-99-91 • Instructions for Implementing and Tracking the Medicare Fraud and Abuse Incentive Reward Program AB-99-92 • Temporary Conversion from Bundled Payments to Regular Medicare Payments for The Participating Centers of Excellence Demonstration Testing Beginning with Discharges after December 31, 1998 AB-99-93 • Extension of the Limitation on Payment for Services to Individuals Entitled to Benefits On the Basis of End Stage Renal Disease Who Are Covered by Group Health Plans AB-99-94 • Reimbursement for Ambulance Services to Non-hospital-Based Dialysis Facilities AB-99-95 • Access to Eligibility Data by Eligibility Verification Vendors AB-99-96 • Data Collection for Program Integrity Y2K Contingency Planning AB-99-97 • HCFA Office of the Inspector General Hotline Referrals AB-99-98 • Extension of Medicare Benefits for Immunosuppressive Drugs AB-99-99 • Cervical or Vaginal Smear Tests (Pap Smears) Included in Calendar Year 2000 Clinical Diagnostic Laboratory Fee Schedule AB-99-100 • Model Acknowledgment Letters for Valid and Invalid Written Statements of Intent to Claim Medicare Benefits (As Referenced In PM Transmittal AB-99-88) AB-99-101 • Section 221 of the Balanced Budget Refinement Act of 1999 “Revision of Provisions Relating to Therapy Services” Program Memorandum State Survey Agencies (HCFA Pub. 65) (Superintendent of Documents No. HE 22.8/6-5) 99-2 • Guideline and Exhibits Regarding Regulatory Requirements for Comprehensive Assessment and Use of the Outcome and Assessment Information Set State Operations Manual Provider Certification (HCFA Pub. 7) (Superintendent of Documents No. HE 22.8/12) 11 • State Agency Identification of Potential Provider and Suppliers Provider-Based Designation Hospital Merger/Multiple Campus Criteria Certification of Hospitals with Multiple Components as Single Hospital 12 • Appendix A, Survey Procedures for Hospitals 13 • Introduction Definitions and Acronyms Emphasis, Components and Applicability Informal Dispute Resolution Certification of Compliance and Noncompliance for Skilled Nursing Facility and Nursing Facilities Action When Facility is not in Substantial Compliance Appeal of Certification of Noncompliance Certification—Related Terms Notice Requirements Timing of Civil Money Penalties Enforcement Action When Immediate Jeopardy Exists Key Dates When Immediate Jeopardy Exists Enforcement Action When Immediate Jeopardy Does Not Exist Special Procedures for Recommending and Providing Notice of Category 1 Remedies and Denial of Payment for New Admissions Key Dates When Immediate Jeopardy Does Not Exist Response to the Plan of Correction New Deficiencies Identified Action When There is Substandard Quality of Care Skilled Nursing Facility/Nursing Facility Readmission to Medicare or Medicaid Program After Termination Enforcement Remedies for Skilled Nursing Facilities and Nursing Facilities Life Safety Code Enforcement Guidelines for Skilled Nursing Facilities and Nursing Facilities Denial of Payment for All New Medicare and Medicaid Admissions for Skilled Nursing Facilities and Nursing Facilities Basis for Imposing Civil Money Penalties Determining Amount of Civil Money Penalty Effective Date of Civil Money Penalty Duration of Civil Money Penalty Appeal of Noncompliance Which Led to Imposition of Civil Money Penalty Notice of Amount Due and Collectible Continuation of Payment During Remediation Sanctions for Inadequate State Survey Performance Peer Review Organization Manual (HCFA Pub. 19) (Superintendent of Documents No. HE 22.8/8-15) 77 • Introduction Assistants at Cataract Surgery Hospital and Medicare+Choice Organization Notices of Non-coverage Hospital-Requested Higher-Weighted Diagnostic Related Group Assignments Potential Concerns Identified During Project Data Collection Referrals 78 • Introduction Quality Improvement Project Process Selecting a Clinical Topic Identifying Quality Indicators Measuring Baseline Performance on Quality Indicators Developing and Conducting Interventions Remeasuring Performance on Quality Indicators Documenting and Disseminating Results National and Regional Projects Local Projects Medicare+Choice Organization Projects Related Activities through Peer Review Organization, Carrier, Intermediary, and End-Stage Renal Disease Network Cooperation Information Collection Publication Policy Project Data Collection 79 • Notice of Discharge and Medicare Appeal Rights Citations and Authority Notice of Discharge and Medicare Appeal Rights Medicare Enrollee Request for Peer Review Organization Immediate Review 80 • Physician/Provider Meeting Activities Required by Statute Physician/Provider Meeting Activities Required by Peer Review Organization Contract Peer Review Organization/Intermediary/Carrier Coordination Activities Additional Peer Review Organization/Carrier Coordination Activities Background Confidentiality Requirements Report Requirements Publication Requirements Hospital Manual (HCFA Pub. 10) (Superintendent of Documents No. HE 22.8/2) 745 • Billing for Mammography Screening 746 • Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines 747 • HCFA Common Procedure Coding System Reporting Outpatient Services Using HCFA Common Procedure Coding System Billing for Hospital Outpatient Partial Hospitalization Services Completion of Form HCFA—1450 for Inpatient and/or Outpatient Billing Home Health Agency Manual (HCFA Pub. 11) Superintendent of Documents No. HE 22.8/5 291 • Billing for Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines Skilled Nursing Facility Manual (HCFA Pub. 12) Superintendent of Documents No. HE 22.8/3 361 • Special Billing Instructions for Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines Medicare Rural Health Clinic & Federally Qualified Health Centers Manual (HCFA Pub. 27) Superintendent of Documents No. HE 22.8/19:985 34 • Billing for Mammography Screening by Rural Health Clinics and Federally Qualified Health Centers Medicare Renal Dialysis Facility Manual (Non-Hospital Operated) (HCFA Pub. 29) Superintendent of Documents No. HE 22.8/13 87 • Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines Hospice Manual (HCFA Pub. 21) Superintendent of Documents No. HE 22.8/18 56 • Billing for Covered Medicare Services After Hospice Benefits are Exhausted • Clarification of Reimbursement for Transfers That Result in Same Day Hospice Discharge and Admission 57 • Special Billing Instructions for Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines Outpatient Physical Therapy and Comprehensive Outpatient Rehabilitation Facility Manual (HCFA Pub. 9) Superintendent of Documents No. HE 22.8/9 7 • Billing Instructions for Partial Hospitalization Services Provided in Community Mental Health Centers 8 • Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines Coverage Issues Manual (HCFA Pub. 6) Superintendent of Documents No. HE 22.8/14 120 • Infusion Pumps 121 • Adult Liver Transplantation Provider Reimbursement Manual—Part 1 (HCFA Pub. 15-1) (Superintendent of Documents No. HE 22.8/4) 410 • Dismissal for Lack of Board Jurisdiction Provider Reimbursement Review Board Jurisdiction 411 • Development of Skilled Nursing Facility Inpatient Routine Service Cost Limits Provider Requests Regarding Applicability of Cost Limits Requests Regarding New Provider Exemption General Requirements Intermediary Responsibilities Regarding Exceptions Provider-Based Designation Classification of Skilled Nursing Facilities for Cost Limit Application 412 • Regional Medicare Swing-Bed Skilled Nursing Facility Rates Provider Reimbursement Manual—Part 2 Provider Cost Reporting Forms and Instructions Chapter 32—Form HCFA-1728-94 (HCFA Pub. 15-2-32) (Superintendent of Documents No. HE 22.8/4) 8 • Home Health Agency Cost Report Provider Reimbursement Manual—Part 2 Provider Cost Reporting Forms and Instructions Chapter 35—Form HCFA-2540-96 (HCFA Pub. 15-2-35) (Superintendent of Documents No. HE 22.8/4) 6 • Skilled Nursing Facility and Skilled Nursing Facility Complex Cost Report 7 • Skilled Nursing Facility and Skilled Nursing Facility Complex Cost Report Provider Reimbursement Manual—Part 2 Provider Cost Reporting Forms and Instructions Chapter 36—Form HCFA-2552-96 (HCFA Pub. 15-2-36) (Superintendent of Documents No. HE 22.8/4) 6 • Hospital and Hospital Health Care Complex, Cost Reporting Form Provider Reimbursement Manual—Part 2 Provider Cost Reporting Forms and Instructions Chapter 37—Form HCFA-2540S-97 (HCFA Pub. 15-2-37) (Superintendent of Documents No. HE 22.8/4) 2 • Skilled Nursing Facility Cost Report State Medicaid Manual—Part 4 Services (HCFA Pub. 45-5) Superintendent of Documents No. HE 22. 8/10 73 • Personal Care Services Medicare/Medicaid Sanction—Reinstatement Report (HCFA Pub. 69) 99-10 • Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—September 1999 99-11 • Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—October 1999 99-12 • Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—November 1999 January 2000 through March 2000 Intermediary Manual Part 3—Claims Process (HCFA Pub. 13-3) (Superintendent of Documents No. HE 22.8/6) 1788 • Provider Electronic Billing File Record Formats 1789 • HCFA Common Procedure Coding System for Hospital Outpatient Radiology Services and Other Diagnostic Procedures 1790 • Oral Cancer Drugs 1791 • Claims Processing Timeliness Carriers Manual Part 2—Program Administration (HCFA Pub. 14-2) (Superintendent of Documents No. HE 22.8/7-3) 140 • Function Standards for Claims Processing Claims Operations Carriers Manual Part 3—Program Administration (HCFA Pub. 14-3) (Superintendent of Documents No. HE 22.8/7) 1658 • Billing Requirement for Global Surgeries 1659 • External Counterpulsation 1660 • Clinical Psychologists Services 1661 • National Emphysema Treatment Trial Background Coverage Summary Beneficiaries Participating in the Study Sites of Service Format for Submitted Claims Identifying National Emphysema Treatment Trial Bypassing Existing Edits in Your System Common Working File Processing of National Emphysema Treatment Trial Dates of Service Late Claim Submission Termination of the Beneficiary's Participation Coding Payment Managed Care Responding to Billing Questions Denied Claims Participating Clinical Center 1662 • Transmyocardial Revascularization Medicare Coverage of Abortion Services 1663 • Pancreas Transplants Billing Instructions Pancreas Transplants Program Memorandum Intermediaries (HCFA Pub. 60A) (Superintendent of Documents No. HE 22.8/6-5) A-00-01 • Consolidated Billing for Skilled Nursing Facility Patients When Receiving Outpatient Emergency Care in a Medicare-Participating Hospital or Critical Access Hospital A-00-02 • Installation of the Medicare Outpatient Code Editor Version 15.1 A-00-03 • Implementation of H. R. 3426, the Medicare, Medicaid, and the State Child Health Insurance Program Balanced Budget Refinement Act of 1999, P.L 106-113, Section 301 (a) Which Provides an Adjustment to Defray the Cost Incurred by a Home Health Agency Attributable to Data Collection and Reporting Requirements Under the Outcome and Assessment Information Set A-00-04 • Provider Statistical and Reimbursement Report Unibill Record A-00-05 • Claims Processing Instructions for the National Institutes of Health National Emphysema Treatment Trial A-00-06 • Instructions for an End-Stage Renal Disease Facility to Retain Its Previously Approved Exception Payment Rate A-00-07 • Addition of Modifiers 25, 58, 78, and 79 to the List of Modifiers Approved for Hospital Outpatient Use and Correction to Program Memorandum A-99-41 A-00-08 • Payment Safeguard Review of Skilled Nursing Facility Prospective Payment Bills—Updated Instructions A-00-09 • Hospital Outpatient Services Prospective Payment System Background A-00-10 • Discarding Program Memoranda on Surety Bonds A-00-11 • Medicare Home Health Benefit-Section 4615 of the Balanced Budget Act of 1997, Clarification That No Home Health Benefits Are Authorized Based Solely on Drawing Blood A-00-12 • Revision of Final Date to Accept Abbreviated Version of the UB-92 for Encounter Data Collection A-00-13 • Procedures for Financial Reporting of Medicare Letter of Credit Draws and Collections between the Hospital Insurance and Supplemental Medicare Insurance Trust Funds A-00-14 • Hospital Outpatient Radiology Services A-00-15 • Hospital Outpatient Procedures: Medicare Changes for Radiology and Other Diagnostic Coding Due to the 1998 HCFA Common Procedure Coding System Update: Changes Miscellaneous A-00-16 • The Balanced Budget Refinement Act Revision to PM Trasmittal No. A-99-51: FY 2000 Prospective Payment System and Excluded Hospital Bill Processing Changes—Wage Adjust 75th Percentile Cap of the Target Amounts or Excluded Hospitals and Units Program Memorandum Carriers (HCFA Pub. 60B) (Superintendent of Documents No. HE 22.8/6-5) B-00-01 • Paramedic Intercept Provisions of the Balanced Budget Act of 1997 B-00-02 • Payment for Teleconsultations in Rural Health Professional Shortage Areas B-00-03 • Emergency Change to the 2000 Medicare Physician Fee Schedule Database B-00-04 • Fee-for Services Enrollment of Managed Care Organizations for the Indirect Payment Procedure B-00-05 • Adjustment to Remittance Advice Explanation of Medicare Benefits and Medicare Summary Notice Messages Generated by Carriers for Services Subject to the Facility/Non-Facility Payment Differential on the Medicare Physician Fee Schedule Database B-00-06 • Matrix to Complete Provider/Supplier Enrollment Application (Form HCFA-855 ) B-00-07 • Change to Correct Coding Edits, Version 6.1, Effective April 1, 2000 B-00-08 • Instruction for Usage of the Revised Oxygen Certificate of Medical Necessity Form 484.2 (11/99) B-00-09 • Clarification of Medicare Policies Concerning Ambulance Services B-00-10 • First Quarterly Update to the 2000 Medicare Physician Fee Schedule Database B-00-11 • Paramedic Intercept—New Definition for Rural B-00-12 • Notification Process for Changes to Health Professional Shortage Area Designations B-00-13 • Calculation of National Standard Format for Electronic Remittance Advice Amount Fields and Balancing of National Standard Format Data; and Clarification to Claim National Standard Format Field EAO 21 for Coordination of Benefits—Modification of Program Memorandum B-99-42 (CR1016) of December 1999 Program Memorandum Intermediaries/Carriers (HCFA Pub. 60A/B) (Superintendent of Documents No. HE 22.8/6-5) AB-00-01 • Prospective Payment System for Outpatient Rehabilitation Services and Application of Financial Limitation AB-00-02 • Durable Medical Equipment Regional Carrier—Pre Discharge Delivery of Durable Medical Equipment Prosthetic, Orthotics & Supplies for Fitting and Training AB-00-03 • Notice of New Interest Rate for Medicare Overpayments and Underpayments AB-00-04 • April Quarterly Update for 2000 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Fee Schedule AB-00-05 • Operating Instructions for Expanded Coverage of the Electrical Osteogenic Stimulator for Fracture Healing. Effective for Services Performed on or after 4/1/2000 AB-00-06 • Do not Forward Initiative AB-00-07 • Moratorium on Data Center Movements AB-00-08 • Payment for All Comprehensive Outpatient Rehabilitation Facility Services Under the Medicare Physician Fee Schedule AB-00-09 • Transmittal number AB-00-09 has been reserved for Y2k contingency planning and will have a limited distribution. AB-00-10 • Implementing Instructions for Services Provided in Religious Nonmedical Health Care Institutions AB-00-11 • Medicare Secondary Payer—Identification and Write Off/Adjustment of Medicare Secondary Payer Settlement Related Group Health Plan Based Accounts Receivable, and Write Off of Unsupportable AB-00-12 • Correction to Coordination of Benefits Contractor Numbers AB-00-13 • New Waived Tests—Effective Data Receipt AB-00-14 • Questions and Answers Regarding the Prospective Payment System for Outpatient Rehabilitation Services and Physical Medicine Current Procedural Terminology Coding Guidance AB-00-15 • Delay of Hyperbaric Oxygen Therapy Coverage Policy AB-00-16 • Instructions to All Medicare Contractors for Reporting Audited Year 2000 Costs on the Final Administrative Costs Proposals AB-00-17 • Clarification of Liver Transplant Policy AB-00-18 • Consolidated Billing for Skilled Nursing Facilities—The Balanced Budget Refinement Act of 1999 AB-00-19 • Access to Eligibility Data by Eligibility Verification Vendors AB-00-20 • Guidance on April Release Implementation State Operations Manual Provider Certification (HCFA Pub. 7) (Superintendent of Documents No. HE 22.8/12) 14 • Nurse Aid Training and Competency Evaluation Programs and Competency Evaluation Programs Peer Review Organization Manual (HCFA Pub. 19) (Superintendent of Documents No. HE 22.8/8-15) 81 • Peer Review Organization Responsibilities • Background • Statutory Authority for Memorandum of Agreement • Scope • Provider Memorandum of Agreement Specifications • Introduction • Intermediary/Carrier Memorandum of Agreement Specifications Hospital Manual (HCFA Pub. 10) (Superintendent of Documents No. HE 22.8/2) 748 • HCFA Common Procedure Coding System for Hospital Outpatient Radiology Services and Other Diagnostic Procedures 749 • Oral Cancer Drugs Oral Anti-Nausea Drugs as Full Therapeutic Replacements for Intravenous Dosage Forms as Part of a Cancer Chemotherapeutic Regimen 750 • Claims Processing Timelines Home Health Agency Manual (HCFA Pub. 11) Superintendent of Documents No. HE 22.8/5 292 • Claims Processing Timeliness Skilled Nursing Facility Manual (HCFA Pub. 12)Superintendent of Documents No. HE 22.8/3 362 • Claims Processing Timeliness Rural Health Clinic Manual & Federally Qualified Health Centers Manual (HCFA Pub. 27) Superintendent of Documents No. He 22.8/19:985 35 • Claims Processing Timeliness Renal Dialysis Facility Manual (Non-Hospital Operated) (HCFA Pub. 29) Superintendent of Documents No. 22. 8/13 88 • Claims Processing Timeliness Hospice Manual (HCFA Pub. 21) Superintendent of Documents No. HE 22. 8/18 58 • Claims Processing Timeliness Outpatient Physical Therapy and Comprehensive Outpatient Rehabilitation Facility Manual (HCFA Pub. 9) Superintendent of Documents No. HE 22. 8/9 9 • Claims Processing Timeliness Coverage Issues Manual (HCFA Pub. 6)Superintendent of Documents No. HE 22. 8/14 122 • External Counterpulsation for Severe Angina 123 • Osteogenic Stimulation Provider Reimbursement Manual—Part 1 (HCFA Pub. 15-1) (Superintendent of Documents No. HE 22.8/4) 413 • Travel Expense State Medicaid Manual Part 2—State Organization and General Administration (HCFA Pub. 45-2) Superintendent of Documents No. HE 22. 8/10 92 • Compliance with Disclosure of Information on Physician Incentive Plan Regulations Medicare/Medicaid Sanction—Reinstatement Report (HCFA Pub. 69) 00-01 Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—December 1999 00-02 Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—January 2000 00-03 Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—February 2000 [April 2000 through June 2000] Intermediary Manual Part 2—Claims Process (HCFA Pub. 13-2) (Superintendent of Documents No. HE 22.8/6) 413 • Assessment of Benefit Savings Attributable to Medical Review Activities 414 • These Manual Changes Reflect Budget Performance Requirements implemented in Fiscal Year 2000 for the Beneficiary Telephone Customer Service Intermediary Manual Part 3—Claims Process (HCFA Pub. 13-3) (Superintendent of Documents No. HE 22.8/6) 1792 • Payment for Blood Clotting Factor Administered to Hemophilia Inpatients 1793 • Clarification of Reimbursement for Transfers That Result in Same Day Hospice Discharge and Admission 1794 • Billing for Abortion Services 1795 • Review of Form HCFA-1450 for Inpatient and Outpatient Bills Review of Hospice Bills 1796 • Provider Electronic Billing File and Record Formats 1797 • Routine Services and Appliances Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines 1798 • Limitation of Liability for Provider Claims Under Parts A and B of Medicare Program Medical Review for Coverage of Skilled Nursing Facility Services 1799 • Medicare Rural Hospital Flexibility Program Requirements for Critical Access Hospital Services and Critical Access Hospital Long-Term Care Services Payment for Services Furnished by a Critical Access Hospital Services Carriers Manual Part 2—Claims Process (HCFA Pub. 14-2) (Superintendent of Documents No. HE 22.8/7) 141 These Manual Changes Reflect Budget Performance Requirements Implemented in Fiscal Year 2000 for Beneficiary Telephone Customer Service Carriers Manual Part 3—Claims Process (HCFA Pub. 14-3) (Superintendent of Documents No. HE 22.8/7) 1664 • Payment for Oral Anti-Emetic Drugs When Used as Full Replacement for Intravenous Anti-Emetic Drugs as Part of a Cancer Chemotherapeutic Regimen Claims Processing Jurisdiction 1665 • Correction in Section G, to the Type of Service for 78267 and 78268 1666 • Chiropractic Services 1667 • Reasonableness and Necessity Billing for Pneumococcal, Hepatitis B, and Influenza Virus Vaccines Billing Requirements Payment Requirements Simplified Roster Bills 1668 • Durable Medical Equipment, Prosthetic, and Orthotic Supplies: Contents have been moved to the Program Integrity Manual (Pub. 83) Medical Review Program General Information: Contents have been moved to the Program Integrity Manual (Pub. 83) Fraud and Abuse Background, Exhibits and Appendices: Contents have been moved to the Program Integrity Manual (Pub. 83) 1669 • Durable Medical Equipment Regional Carrier Billing Procedures Program Memorandum Intermediaries (HCFA Pub. 60A) (Superintendent of Documents No. HE 22.8/6-5) A-00-17 • Change to FY 2000 Hospital Prospective Payment System Policies as Required by the Medicare, Medicaid, and State Child Health Insurance Program Balanced Budget Refinement Act of 1999, P. L. 106-113 A-00-18 • Fiscal Intermediary Community Mental Health Center Enrollment and Change of Ownership Site Visit Process and Coordination with National Site Visit Contractor A-00-19 • Implementation of Provider Enrollment, Chain and Ownership System A-00-20 • The Report of Benefit Savings A-00-21 • Revised Outpatient Code Editor Specifications for the Outpatient Prospective Payment System A-00-22 • Instructions For Reporting Additional Detailed Information of Form HCFA-750 Contractor Financial Report (Fiscal Intermediaries Only) A-00-23 • Hospital Outpatient Prospective Payment System Implementation Instructions A-00-24 • Upcoming Training on Home Health Prospective Payment System, Outpatient Prospective Payment System and Skilled Nursing Prospective Payment System Refinements and Consolidated Billing A-00-25 • Provider Statistical and Reimbursement Report A-00-26 • Payment of Skilled Nursing Facility Claims for Beneficiaries Disenrolling from Terminating Medicare+Choice Plans Who Have Not Met the 3-Day Stay Requirement A-00-27 • Permitting Reclassification of Certain Urban Hospitals as Rural Application Procedures A-00-28 • Clarification of Provider Cost Report Filing Requirements A-00-29 • Electronic Filing of Provider Cost Reports; Home Health Agencies and Skilled Nursing Facilities A-00-30 • Announcement of Medicare Rural Health Clinics and Federally Qualified Health Centers Payment Rate Increases and Policy Clarifications and Guidance for Services Furnished by Rural Health Clinics and Federally Qualified Health Centers A-00-31 • Reporting a Patient's Reason for Visit on a Part A Outpatient Claim A-00-32 • Effectuating Favorable Final Appellate Decisions That a Beneficiary is “Confined to Home”—Regional Home Health Intermediaries Only A-00-33 • Education and Outreach to Coordination of Benefits Trading Partners A-00-34 • Provider Statistical and Reimbursement Report A-00-35 • Revised Outpatient Code Editor Specifications for the Outpatient Prospective Payment System A-00-36 • Hospital Outpatient Prospective Payment System Implementation Instructions A-00-37 • Line Item Denials and the Reporting of Savings Generated by Claim Expansion and Line Item Processing Program Memorandum Carriers (HCFA Pub. 60B) (Superintendent of Documents No. HE 22.8/6-5) B-00-14 • Revisions to Durable Medical Equipment Regional Carrier Information Form (DIF) Immunosuppressive Drugs Durable Medical Equipment Regional Carrier Form (latest revision 7/25/95) B-00-15 • Change to Health Insurance Claim Form HCFA-1500 Instructions for Processing Physician Claims in Global Payment Systems B-00-16 • Provider Education Article: Role of Physicians in the Home Health Prospective Payment System B-00-17 • Emergency Changes to the 2000 Medicare Physician Fee Schedule Database B-00-18 • Emergency Changes to the 2000 Medicare Physician Fee Schedule Database B-00-19 • Durable Medical Equipment Regional Carrier Report on Expansion of Immunosuppressive Drugs B-00-20 • Collection and Submission of Data for the Provider Enrollment and Chain Ownership System B-00-21 • 2000 Jurisdiction List B-00-22 • Durable Medical Equipment Regional Carriers and New Oral Anti-Cancer Drugs Approved for Use by Medicare B-00-23 • Business Requirements For Processing Physician Encounter Data In The HCFA Data Center B-00-24 • Issues Involving Certificates of Medical Necessity Certified Medical Necessity and Cover Letters for Certified Medical Necessity B-00-25 • New Temporary K Codes for Hydrogel Impregnated Gauze B-00-26 • Carrier Adjustments to be Made for Payment for HCFA Common Procedure Coding System Code 90669, Pneumococcal Conjugate Vaccine, Polyvalent, for Intramuscular Use B-00-27 • Durable Medical Equipment Regional Carriers Common Working File Changes for Codes J8999, E0784, E0781, A4230-4232, E0616, and E0749 B-00-28 • Billing of Influenza (Flu) and Pneumococcal Pneumonia Vaccine Virus Claims for Authorized Centralized Billing Providers to be Processed Through One Designated Carrier B-00-29 • Correct Effective Date for Adjustment in Payment Amounts for New Technology Intraocular Lenses Furnished by Medicare-Approved Ambulatory Surgical Centers B-00-30 • Clarification of Billing for G0170 and G0171 B-00-31 • Use of Common Procedural Terminology Code 33999 for Transmyocardial Revascularization B-00-32 • Common Procedural Terminology Codes 99214 and 99233 B-00-33 • Changes to Correct Coding Edits, Version 6.2, Effective July 1, 2000 Program Memorandum Intermediaries/Carriers (HCFA Pub. 60A/B) (Superintendent of Documents No. HE 22.8/6-5) AB-00-21 • Self-Administered Injectable Drugs and Biologicals AB-00-22 • “No Fee” Policy for Medicare Contractors' Provider Education and Training Activities Program Management and Medicare Integrity Program Funded Activities AB-00-23 • Medigap (Medicare Supplemental Insurance) Insurers Fraud Referrals AB-00-24 • Development and Dissemination of a Product Classification List for HCFA Common Procedure Coding System Code L0430 AB-00-25 • Contractor Testing Requirements AB-00-26 • July Quarterly Update for 2000 Durable Medical Equipment, Prosthetics Orthotics, and Supplies AB-00-27 • Medicare Secondary Payer Government Performance and Results Act Goal for Fiscal Year 2000 AB-00-28 • Update of Rates for Ambulatory Surgical Center Payments AB-00-29 • Comprehensive Error Rate Testing Program—Medicare Contractor Change Requirements and Medicare Part B/Durable Medical Equipment Regional Carrier Standard System Change Requirements AB-00-30 • Implementing Instructions for Services Provided in Religious Nonmedical Health Care Institutions AB-00-31 • Sending Common Working File Referrals for Initial Enrollment Questionnaire and Internal Revenue Services/Social Security Administration/Health Care Financing Administration Data Match Records to the Coordination of Benefits Contractor AB-00-32 • New Waived Tests AB-00-33 • Processing of Medicare+Choice Encounter Data at the Health Care Financing Administration Data Center AB-00-34 • Program Integrity Management Reporting System AB-00-35 • Further Guidance on April Release Implementation AB-00-36 • Transfer of Initial Medicare Secondary Payer Development Activities to the Coordination of Benefits Contractor AB-00-37 • Notice of New Interest Rate for Medicare Overpayments and Underpayments AB-00-38 • Consolidation of Program Memorandums for Outpatient Rehabilitation Therapy Services AB-00-39 • Consolidation of Program Memorandums for Outpatient Rehabilitation Therapy Services AB-00-40 • Written Statements of Intent to Claim Medicare Benefits; 60-Day Grace Period AB-00-41 • Procedures for the Benefit Integrity and Medical Review Units on Unsolicited Voluntary Refund Checks AB-00-42 • Claims Processing Instructions for the Medicare Coordinated Care Demonstration AB-00-43 • Program Memorandum on Written Statements of Intent to Claim Medicare Benefits AB-00-44 • Medicare Coverage of Non-Invasive Vascular Studies When Used to Monitor the Access Site of End-Stage Renal Disease Patients AB-00-45 • Award of Medicare+Choice Contract to Sterling Life Insurance Co., Inc. for Medicare+Choice Private Fee-for-Service Plan AB-00-46 • Health Care Financing Administration Policy for Disclosure of Individually Identifiable Information AB-00-47 • Release to Be Implemented June 5, 2000 AB-00-48 • Model Acknowledgment Letters for Valid and Invalid Written Statements of Intent to Claim Medicare Benefits (As Referenced in PM Transmittal AB-99-88) AB-00-49 • Program Memorandum on Statements of Intent to File Claims for Claims Filing Periods that End on December 31, 1999 AB-00-50 • Medicare Fraud Information Specialist Position AB-00-51 • Claims Processing Instructions for Claims Submitted With a Written Statement of Intent AB-00-52 • Assisted Suicide Funding Restriction Act of 1997 (P. L. 105-12) AB-00-53 • Suspension of National Coverage Policy on Electrostimulation for Wound Healing AB-00-54 • Modified Procedures for Sharing Health Care Financing Administration Data with the Department of Justice AB-00-55 • Hemodialysis Flow Study AB-00-56 • Memorandum of Understanding Between the Office of Inspector General and the Department of Justice—Sharing Fraud Referrals AB-00-57 • Contractor Updating of the International Classification of Diseases, Ninth Revision, Clinical Modification AB-00-58 • Guidance on Implementation of the Calendar Year 2000 Third Quarter Release AB-00-59 • Correction to July Quarterly Update for 2000 Durable Medical Equipment Prosthetics, Orthotics, and Supplies Fee Schedule AB-00-60 • Future Software Releases AB-00-61 • New Waived Tests AB-00-62 • Rescinding Change Requests Numbers 1001, 1108, 1116, and 1163 AB-00-63 • Ocular Photodynamic Therapy AB-00-64 • Medicare Summary Notice Implementation at Seven Contractor Sites AB-00-65 • Business and System Requirements for the Home Health Prospective Payment System State Operations Manual—Provider Certification (HCFA Pub. 7) Superintendent of Documents No. HE 22.8/12 16 • Medicare/Medicaid Certification and Transmittal, Form HCFA-1539 Change in Size or Location of Participating Skilled Nursing Facility and/or Nursing Facility Regional Office Verifying Continued Compliance with Exclusion Criteria by Currently Excluded Hospitals or Units Change in Size or Location of Participating Skilled Nursing Facility and/or Nursing Facility Change in Provider Location and/or Bed Complement—Other Than Distinct Part 17 • Condition of Participation: Patients' Rights Hospice Manual (HCFA Pub. 10) (Superintendent of Documents No. HE 22.8/2) 751 • Payment for Blood Clotting Factor Administered to Hemophilia Inpatients 752 • Billing for Mammography Screening 753 • Billing for Abortion Services 754 • Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines 755 • Disclosure of Itemized Statement to an Individual for Any Item or Service Provided 756 • Fraud and Abuse—General: Contents have been moved to the Program Integrity Manual (Pub. 83) Focused Medical Review: Contents have been moved to the Program Integrity Manual (Pub. 83) Billing for Part B Intermediary Outpatient Occupational Therapy Services: Contents have been moved to the Program Integrity Manual (Pub. 83) Special Instructions for Billing Dysphagia: Contents have been moved to the Program Integrity Manual (Pub. 83) 757 • Medicare Rural Hospital Flexibility Program Requirements for Critical Access Hospital Services and Critical Access Hospital Long-term Care Services Payment for Services Furnished by a Critical Access Hospital Home Health Agency Manual (HCFA Pub. 11) Superintendent of Documents No. HE 22.8/5 293 • Billing for Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines 294 • Disclosure of Itemized Statement to an Individual for Any Item or Service Provided 295 • Fraud and Abuse—General: Contents have been moved to the Program Integrity Manual (Pub. 83) Billing for Part B—Outpatient Physical Therapy Services: Contents have been moved to the Program Integrity Manual (Pub. 83) Focused Medical Review: Contents have been moved to the Program Integrity Manual (Pub. 83) Skilled Nursing Facility Manual (HCFA Pub. 12) Superintendent of Documents No. HE 22.8/3 363 • Special Billing Instructions for Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines 364 • Distinct Part of an Institution as a Skilled Nursing Facility 365 • Disclosure of Itemized Statement to an Individual for Any Item or Service Provided 366 • Fraud and Abuse—General: Contents have been moved to the Program Integrity Manual (Pub. 83) Focused Medical Review: Contents have been moved to the Program Integrity Manual (Pub. 83) Billing Part B Intermediary Outpatient Physical Therapy Bills: Contents have been moved to the Program Integrity Manual (Pub. 83) Rural Health Clinic Manual & Federally Qualified Health Centers Manual (HCFA Pub. 27) Superintendent of Documents No. He 22. 8/19:985 36 • Disclosure of Itemized Statement to an Individual for Any Item or Service Provided Renal Dialysis Facility Manual (Non-Hospital Operated) (HCFA Pub. 29) Superintendent of Documents No. 22.8/13 89 • Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines 90 • Disclosure of Itemized Statement to an Individual for Any Item or Service Provided ESRD Network Organizations Manual (HCFA Pub. 81) Superintendent of Documents No. HE 22.9/4 10 • Organizational Structure Medical Review Board Other Committees Network Staff Administrative Reports Health Care Financing Administration Meeting Cooperative Activities with State Survey Agencies and Peer Review Organizations Annual Report Format Hospice Manual (HCFA Pub. 21) Superintendent of Documents No. HE 22.8/18 59 • Completion of the Uniform (Institutional Provider) Bill (HCFA-1450) for Hospice Bills 60 • Special Billing Instructions for Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines 61 • Disclosure of Itemized Statement to an Individual for Any Item or Services Provided 62 • Fraud and Abuse: Contents have been moved to the Program Integrity Manual (Pub. 83) Focused Medical Review: Contents have been moved to the Program Integrity Manual (Pub. 83) Outpatient Physical Therapy and Comprehensive Outpatient Rehabilitation Facility Manual (HCFA Pub. 9) Superintendent of Documents No. HE 22.8/9 10 • Pneumococcal Pneumonia, influenza Virus, and Hepatitis B Vaccines 11 • Disclosure of Itemized Statement to an Individual for Any Item or Service Provided 12 • Fraud and Abuse—General: Contents have been moved to the Program Integrity Manual (Pub. 83) Medical Review of Comprehensive Outpatient Rehabilitation Facility Claims: Contents have been moved to the Program Integrity Manual (Pub. 83) Focused Medical Review: Contents have been moved to the Program Integrity Manual (Pub. 83) Intermediary Medical Review of Part B Outpatient Physical Therapy: Contents have been moved to the Program Integrity Manual (Pub. 83) Coverage Issues Manual (HCFA Pub. 6) Superintendent of Documents No. HE 22.8/14 124 • Pancreas Transplants Provider Reimbursement Manual—Part 1 (HCFA Pub. 15-1) (Superintendent of Documents No. HE 22.8/4) 414 • Effective Date of Change in Bed Size and/or Bed Designation(s) of Participating Skilled Nursing Facility and/or Nursing Facility Requirements for Distinct Part Certification Changes in Bed Size of Participating Skilled Nursing Facility and/or Nursing Facility General Request Filing Requirements Exceptions Change in Designated Bed Location(s) Cost Report Requirement after Change in Bed Size and/or Change in Designated Bed Location(s) 415 • Historical Costs Purchase of Facility as Ongoing Operation Useful Life of Depreciable Assets Salvage Value Disposal of Assets Gains or Loss on Disposal of Depreciable Assets (Excluding Involuntary Conversions) Bona Fide Sale Sale and Leaseback and Lease-Purchase Agreement 416 • Right to Board Hearing Individual Appeals Group Appeals Expedited Judicial Review Request for Board Hearing or for Expedited Judicial Review Provider Reimbursement Manual—Part 2 Provider Cost Reporting Forms and Instructions Chapter 18—Form HCFA-2088-92 (HCFA Pub. 15-2-32) (Superintendent of Documents No. HE 22.8/4) 9 • Home Health Agency Cost Reporting Form HCFA-1728-94 State Medicaid Manual—Part 4/Services (HCFA Pub. 45-6) Superintendent of Documents No. HE 22.8/10 36 • Updates ingredient prices used by States to establish upper limits for prescription drugs Medicare Program Integrity Manual (HCFA Pub. 83) 1 • Medical Review and Benefit Integrity Programs Sources to Identify Aberrancies, and Developing Fraud or Abuse Cases Corrective Actions Examples of Fraudulent Activities Items and Services Having Special Durable Medical Equipment Regional Carrier Review Considerations Intermediary Medical Review Guidelines for Specific Services Medical Review Reports Program Memoranda Medical Review Information Reported Electronically Medicare/Medicaid Sanction—Reinstatement Report (HCFA Pub. 69) 00-04 • Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded Reinstated—March 2000 00-05 • Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—April 2000 00-06 • Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—May 2000 [July through September 2000] Intermediary Manual Part 3—Claims Process HCFA Pub. 13-3) (Superintendent of Documents No. HE 22.8/6) 1800 • Provider Electronic Billing File and Record Formats 1801 • Prostate Cancer Screening Tests and Procedures 1802 • Bill Review for Partial Hospitalization Services Provided in Community Mental Health Centers 1803 • Information Regarding the Release of Medicare Eligibility Data New Policy on Releasing Eligibility Data Advise Your Providers and Network Service Vendors Network Service Agreement 1804 • Review of Form HCFA-1450 for Inpatient and Outpatient Bills Outpatient Services Hospital Outpatient Partial Hospitalization Services Calculating the Part B Payment Addition, Deletion and Change of Local Codes Reporting Hospital Outpatient Services Using Health Care Financing Administration Common Procedure Coding System 1805 • Stem Cell Transplantation Allogeneic Stem Cell Transplantation Autologous Stem Cell Transplantation Acquisition Costs 1806 • Pancreas Transplants 1807 • Screening Pap Smears and Screening Pelvic Examinations 1808 • Billing by Home Health Agencies Under Cost/Interim Payment System Reimbursement Billing by Home Health Agencies Under the Home Health Prospective Payment System When Bills Are Submitted Billing for Nonvisit Charges Durable Medical Equipment Furnished as a Home Health Benefit More Than One Agency Furnished Home Health Services Home Health Services Are Suspended or Terminated Then Reinstated Preparation of a Home Health Billing Form in No-Payment Situations Billing for Part B Medical and Other Health Services Reimbursement of Home Health Agency Claims Osteoporosis Injections as Home Health Agency Benefit Completion of Form HCFA-1450 for Home Health Agency Billing Under Home Health Prospective Payment Requests for Anticipated Payment Home Health Prospective Payment System Claims Home Health Prospective Payment System Claims When No Request for Anticipated Payment Was Submitted Background on Home Health Prospective Payment System Creation of Home Health Prospective Payment System Regulatory Implementation of Home Health Prospective Payment System Commonalities of the Cost Reimbursement and Home Health Prospective Payment System Environment Effective Date and Scope of Home Health Prospective Payment System for Claims Configuration of the Home Health Prospective Payment System Environment New Software for the Home Health Prospective Payment System Environment The Home Health Prospective Payment System Episodes Effect of Election of Health Maintenance Organization and Eligibility Changes on Home Health Prospective Payment System Episodes Split Percentage Payment of Episodes and Development of Episode Rates Basis of Medicare Prospective Payment System and Case Mix Coding of Home Health Prospective Payment System Episode Case-Mix Groups On Home Health Prospective Payment System Claims: Research Group and Health Insurance Prospective Payment System Codes Composition of Health Insurance Prospective Payment System Codes for Home Health Prospective Payment System Significance of Health Insurance Prospective Payment Systems Overview of the Provider Billing Process Under Home Health Prospective Payment Overview—Grouper Links Assessment and Payment Overview—Health Insurance Query Access System Shows Primary Home Health Agency Overview—Request for Anticipated Payment: Submission and Processing Establishes Home Health Prospective Payment System Episode and Provides First Percentage Payment Overview—Claim Submission and Processing Completes Home Health Prospective Payment System Payment, Closes Episode and Performs A-B Shift Overview—Payment, Claim Adjustments and Cancellations Definition of the Request for Anticipated Payment Definition of Transfer Situation Under Home Health Prospective Payment System Payment Effects Payment When Death Occurs During a Home Health Prospective Payment System Episode Adjustments of Episode Payment—Low Utilization Payment Adjustments Adjustments of Episode Payment—Low Utilization Payment Adjustment Adjustments of Episode Payment—Special Submission Case: “No-Request Anticipated Payment” Low Utilization Payment Adjustments Adjustments of Episode Payment—Therapy Threshold Adjustments of Episode Payment—Partial Episode Payment Adjustments of Episode Payment—Significant Change in Condition Adjustments of Episode Payment—Outlier Payments Adjustments of Episode Payment—Exclusivity and Multiplicity of Adjustments Seven Scenarios for Home Health Prospective Payment Adjustment General Guidance on Line Item Billing Under Home Health Prospective Payment System Acronym Table Home Health Prospective Payment System Consolidated Billing and Primary Home Health Agency New Common Working File Requirements for the Home Health Prospective Payment System Creation of the Health Insurance Query System for Home Health Agencies And Hospices in the Common Working File—Replacement of Health Insurance Query System for Home Health Agencies Health Insurance Query Access System Inquiry and Response Timeliness and Limitations of Health Insurance Query System for Home Health Agency Responses Inquiries to Regional Home Health Intermediaries Based on Health Insurance Query System for Home Health Agency Responses National Home Health Prospective Payment Episode History File Opening and Length of Home Health Prospective Payment System Episodes Closing, Adjusting and Prioritizing Home Health Prospective Payment System Episodes Based on Request for Anticipated Payment and Home Health Prospective Payment System Episodes Based on Request for Anticipated Payment and Home Health Agency Claim Activity Other Editing and Changes for Home Health Prospective Payment System Episodes Priority Among Other Claim Types and Home Health Prospective Payment System Consolidated Billing for Episodes Medicare Secondary Payment and the Home Health Prospective Payment System Episode File Chart Summarizing Effects of Request for Anticipated Payment/Claim Actions on the Home Health Prospective Payment System Episode File Home Health Prospective Payment System Episode File Pricer Program Outpatient Prospective Payment System Remittance Advice Instructions and 3753, Home Health Prospective Payment System Remittance Advice Instructions 1809 • Under Arrangements Outpatient Hospital Psychiatric Services Partial Hospitalization Services 1810 • Definition of Medicare Secondary Payer/Common Working File Medicare Secondary Payer Maintenance Transaction Record Processing Carriers Manual Part 3—Claims Process (HCFA Pub. 14-3) (Superintendent of Documents No. HE 22.8/7) 1670 • Echocardiography Services (Codes 93303—93350) 1671 • Magnetic Resonance Angiography Magnetic Resonance Angiography Coverage Summary Coding Requirements Payment Requirements and Methodology Format for Submitting Medicare Carrier Claims Claims Editing 1672 • Claims Processing Jurisdiction 1673 • Information Regarding the Release of Medicare Eligibility Data New Policy on Releasing Eligibility Data Advise Your Provider and Network Services Vendors Network Service Agreement 1674 • Stem Cell Transplantation General HCFA Common Procedure Coding System and Diagnosis Code Non-Covered Conditions Edits Suggested Medicare Summary Notice/Explanation of Medicare Benefits and Regional Administrator Messages 1675 • Screening Pap Smear and Pelvic Examination Screening Pap Smears Billing Requirements Common Working File Edits Medicare Summary Notices and Explanation of Your Medicare Benefits Message Remittance Advice Notices Screening Pelvic Examination 1676 • HCFA Common Procedure Coding System and Payments Requirements Calculating the Frequency Common Working File Edits Correct Coding Requirements Diagnosis Coding Requirements Denial Messages 1677 • Definition of Medicare Secondary Payor/Common Working File Terms Medicare Secondary Payor Maintenance Transaction Record Processing 1678 • Medicare Physician Fee Schedule Database 2001 File Layout Carriers Manual Part 4—Professional Relations (HCFA Pub. 14-4) (Superintendent of Documents No. HE 22.8/7-4 22 • Enrollment Procedures for General Application Program Memorandum Intermediaries (HCFA Pub. 60A) (Superintendent of Documents No. HE 22.8/6-5) A-00-38 • Change in Hospice Payment Rates, Update to the Hospice Cap, Revised Hospice Wage Index and Hospice Pricer A-00-39 • Monitoring Process for Skilled Nursing Facility Exception Determinations A-00-40 • Further Information on the Use of Modifier -25 in Reporting Hospital Outpatient Services A-00-41 • Transition to the Home Health Prospective Payment System A-00-42 • Coding Information for Hospital Outpatient Prospective Payment System A-00-43 • Advance Beneficiary Notices for Services for Which Institutional Part B Claims Will be Processed by Fiscal Intermediaries A-00-44 • Outpatient Prospective Payment System Contingency Plans and Instructions A-00-45 • Interim Process for Certain “Inpatient Only” Code Changes A-00-46 • Skilled Nursing Facility Adjustment Billing: Adjustments to Health Insurance Prospective Payment System Codes Resulting From Minimum Data Set Corrections A-00-47 • Skilled Nursing Facility Annual Update: Prospective Payment System Pricer and Health Insurance Prospective Payment System Coding Changes A-00-48 • Drugs, Biologicals, Devices and New Technology HCFA Common Procedure Coding System Codes For Use Under the Hospital Outpatient Prospective Payment System A-00-49 • Payment of Skilled Nursing Facility Claims for Beneficiaries Disenrolling From Terminating Medicare+Choice Plans Who Have Not Met the 3-Day Hospital Stay Requirement A-00-50 • Department of Veterans Affairs Claims Adjudication Services Project: Systems Changes Needed A-00-51 • Q Codes For Use Under the Hospital Outpatient Prospective Payment System A-00-52 • Community Mental Health Centers Payment Instructions For Outpatient Prospective System Contingency Plans A-00-53 • Proper Billing of Units for Intrathecal Baclofen Under the Outpatient Prospective Payment System A-00-54 • The Supplemental Security Income Medicare Beneficiary Data for Fiscal Year 1999 for Prospective Payment System Hospitals A-00-55 • Provider Statistical and Reimbursement Report A-00-56 • Update of Rates for Ambulatory Surgical Center Payment A-00-57 • Payment of Skilled Nursing Facility Claims for Beneficiaries Disenrolling from Terminating Medicare+Choice Plans Who Have Not Met the 3-Day Stay Required A-00-58 • Destroy Outdated Stock of Medicare Summary Notices and Part A Explanation of Medicare Benefits Under the Hospital Outpatient Prospective Payment System A-00-59 • Home Health Prospective Payment System Phase in Plan, Contingency Plan, and Instructions A-00-60 • Standard Questions and Answers for Beneficiary Inquiries Related to the Hospital Outpatient Prospective Payment System A-00-61 • Update 1—Coding Information for Hospital Outpatient Prospective Payment System A-00-62 • File Descriptions and Instructions for Retrieving the 2001 Physician, Clinical Lab, Durable Medical Equipment, Prosthetics/Orthotics and Supplies Fee Schedule Payment Amounts Through Health Care Financing Administration's Mainframe Telecommunications Systems A-00-63 • Cost-to-Charge Ratios for Calculating Certain Payments Under the Hospital Outpatient Prospective Payment System A-00-64 • Terminating State Access to the Common Working File Eligibility Data A-00-65 • Release of Internal Revenue Service Data Elements on Eligibility Queries A-00-66 • Fiscal Year 2001 Prospective Payment System Hospital and Other Bill Processing Changes A-00-67 • Deactivation of Inactive Community Mental Health Center Medicare Numbers A-00-68 • Provider Statistical and Reimbursement Report A-00-69 • Background and Documentation for Correct Coding Initiative and Unit of Service Edits A-00-70 • Provider Statistical and Reimbursement Report Program Memorandum Carriers (HCFA Pub. 60B) (Superintendent of Documents No. HE 22.8/6-5) B-00-34 • This Transmittal Number Was Inadvertently Skipped and Will Not Be Used In the Future B-00-35 • Addition of Five “WW” Codes to Identify a New Source for Methotrexate B-00-36 • Returned Mail—Unique Physician Identification Number B-00-37 • Standard System Acceptance of Primary Payer Information at the Line Level B-00-38 • Addition of “WW” Codes to Identify a New Source for an Oral Anti-Cancer Drug in Dosages of 25mg and 100mg B-00-39 • Department of Veterans Affairs Claims Adjudication Services Project: Systems Changes Needed B-00-40 • Final Update to the 2000 Medicare Physician Fee Schedule Database B-00-41 • Changes to Correct Coding Edits, Version 6.3, Effective October 1, 2000 B-00-42 • Analysis of Services Provided in Congregate Settings B-00-43 • New Temporary “K” Codes for Negative Pressure Wound Therapy Pumps B-00-44 • Site Visits and Enrollment of Independent Diagnostic Testing Facilities B-00-45 • Reporting of Carrier Pricing Methodology for Influenza and Pneumococcal Vaccinations to Health Care Financing Administration B-00-46 • Changes to Correct Coding Edits, Version 6.2, Effective September 5, 2000 B-00-47 • Addition of Special Processing Number 39 (Centralized Billing of Flu and Pneumococcal Pneumonia Vaccine Claims) to the Common Working File B-00-48 • Claims Processing Instructions for the DME Prosthetic, Orthotics & Supplies Competitive Bidding Demonstration B-00-49 • Implementation of the Health Insurance Portability and Accountability Act Transaction Standards Program Memorandum Intermediaries/Carriers (HCFA Pub. 60A/B) (Superintendent of Documents No. HE 22.8/6-5) AB-00-66 • Coverage of Diabetes Outpatient Self-Management Training Services, Effective: July 1, 1998 AB-00-67 • Implementation of § 4105 of the Balanced Budget Act Regarding Coverage of Diabetes Outpatient Self-Management Training Services AB-00-68 • Current Status of Medicare Program Memoranda Issued Before Calendar Year 2000 AB-00-69 • Notice of New Interest Rate for Medicare Overpayments and Underpayments AB-00-70 • Program Safeguard Contractor for Corporate Integrity Agreements AB-00-71 • Claims Processing Instructions for the Medicare Coordinated Care Demonstration AB-00-72 • Medical Review Progressive Corrective Action AB-00-73 • Proper Billing of Outpatient Pathology Services Under the Outpatient Prospective Payment System AB-00-74 • Transfer of Initial Medicare Secondary Payer Development Activities to the Coordination of Benefits Contractor AB-00-75 • The Internal Control Certification Statement Required by the Budget and Performance Requirements for the Fiscal Year Ending September 30, 2000 AB-00-76 • Modification of Medicare Policy for Erythropoietin AB-00-77 • New State Code for Maryland Provider Numbers AB-00-78 • Reasonable Charge Update for 2001 for Items and Services, Other than Ambulance Services, Still Subject to the Reasonable Change Payment Methodology AB-00-79 • Establishment of Contractor Numbers for Program Safeguard Contractors AB-00-80 • Instruction Implementation Reporting AB-00-81 • Self-Administered Injectable Drugs and Biologicals AB-00-82 • Update of Rates and Wage Index for Ambulatory Surgical Center Payments Effective October 1, 2000 AB-00-83 • Verteporfin (Visudyne) AB-00-84 • Provider Toll-Free Telephone Inquiry Service AB-00-85 • Guidance on Implementation of the Calendar Year 2000 Fourth Quarter Release AB-00-86 • An Additional Source of Average Wholesale Price Data in Pricing Drugs and Biologicals Covered by the Medicare Program AB-00-87 • 2001 Payment Limit for Ambulance Services AB-00-88 • Implementation of the Ambulance Fee Schedule AB-00-89 • Claims Processing Instructions for Carriers, Durable Medical Equipment Regional Carrier, Intermediaries and Regional Home Health Intermediaries for Claims Submitted for Medicare Beneficiaries Participating in Medicare Qualifying Clinical Trials AB-00-90 • Year 2001 Health Care Financing Common Procedure Coding System Annual Update Reminder Program Memorandum Medicaid State Agencies (HCFA Pub. 17) Superintendent of Documents No. HE 22.8/6-5 00-01 • Current Status of Medicaid Program Memoranda and Action Transmittals Issued Before Calendar Year 2000 State Operations Manual—Provider Certification (HCFA Pub. 7) Superintendent of Documents No. HE 22.8/12 18 • Religious Nonmedical Healthcare Institutions Certification of Religious Nonmedical Healthcare Institutions Interpretive Guidelines for Responsibilities of Medicare-Participating Religious Nonmedical Healthcare Institutions 19 • Guidelines for Determining Immediate Jeopardy 20 • Guidance to Surveyors—Long-Term Care Facilities Peer Review Organization (HCFA Pub. 19) Superintendent of Documents No.HE 22.8/8-15 82 • Disclosure of Quality Review Information to Complainants Scope of Review Complaints That Do Not Meet Statutory Requirements Referrals Review Process Notice of Disclosure Final Response to Complainants Disclosure of Quality Review Information to Complainants Request for Information Model Form Final Response to Inquirer Model Notice (Concern Involved Practitioners) Potential Quality Concern Model Notice Hospice Manual (HCFA Pub. 10) (Superintendent of Documents No. HE 22.8/2) 758 • Prostate Cancer Screening Tests and Procedures 759 • Reporting Hospital Outpatient Services Using Health Care Financing Administration Common Procedure Coding System Billing for Hospital Outpatient Partial Hospitalization Services Completion of Form HCFA-1450 for Inpatient and/or Outpatient Billing Addition, Deletion and Change of Local Codes Reporting Hospital Outpatient Services Using Health Care Financing Administration Common Procedures Coding System 760 • Screening Pap Smears and Screening Pelvic Examinations 761 • Outpatient Hospital Psychiatric Services Outpatient Partial Hospitalization Programs Skilled Nursing Facility Manual (HCFA Pub. 12) Superintendent of Documents No. HE 22.8/3 367 • Distinct Part of an Institution as a Skilled Nursing Facility ESRD Network Organizations Manual (HCFA Pub. 81) Superintendent of Documents No. HE 22.9/4 11 • End Stage Renal Disease Health Care Quality Improvement Program Responsibilities Quality Improvement Projects Background and Project Topics Quality Improvement Program Frequency, Project Consultant, and Required Reporting Project Idea Quality Improvement Program Narrative Project Plan Final Project Report Identifying Additional Opportunities for Improvement Quarterly Progress and Status Report Clinical Performance Measures Clinical Performance Measures—Network/National Sample Clinical Performance Measures—Sampling Method Clinical Performance Measures—Data Collection Clinical Performance Measures—Data Validation Clinical Performance Measures—Data Validating Reports Health Care Financing Administration—Compiled Data Reports Network Resources to Support the United States Renal Data System End Stage Renal Disease Clinical Performance Measures Annual Estimate of Patient Sample Per Network for United States Renal Data System Special Studies End Stage Renal Disease Network—Project Idea Document Format End Stage Renal Disease Network—Narrative Project Plan Format End Stage Renal Disease Network—Final Project Report Format Hospice Manual (HCFA Pub. 21) Superintendent of Documents No. HE 22.8/18 63 • Reducing Barriers to Pneumococcal Vaccines Outpatient Physical Therapy and Comprehensive Outpatient Rehabilitation Facility Manual (HCFA Pub. 9) Superintendent of Documents No. HE 22.8/9 13 • Billing Instructions for Partial Hospitalization Services Provided in Community Mental Health Centers 14 • General Partial Hospitalization Defined Patient Eligibility Criteria Documentation Requirements and Physician Supervision Community Mental health Center Requirements Outpatient Mental Health Treatment Limitation Documentation Requirements and Physician Supervision Coverage Issues Manual (HCFA Pub. 6) Superintendent of Documents No. HE 22.8/14 125 • Stem Cell Transplantation 126 • Routine Costs of Clinical Trials Provider Reimbursement Manual—Part 1 (HCFA Pub. 15-1) (Superintendent of Documents No. HE 22.8/4) 417 • Special Treatment of Sole Community Hospitals Under Prospective Payment System Provider Reimbursement Manual—Part 2 Provider Cost Reporting Forms and Instructions Chapter 1—General—2088-92 (HCFA Pub. 15-2-1) (Superintendent of Documents No. HE 22.8/4) 20 • Electronic Submission of Hospital Cost Reports Requirement To File Cost Report Initial Cost Reporting Period Cessation of Participation in Program Cost Report Forms Use of Substitute Cost Reporting Forms Provider Reimbursement Manual—Part 2 Provider Cost Reporting Forms and Instructions Chapter 35—Form HCFA-2540-96 (HCFA Pub. 15-2-35) (Superintendent of Documents No. HE 22.8/4) 8 • Skilled Nursing Facility & Complex Cost Report Provider Reimbursement Manual—Part 2 Provider Cost Reporting Forms and Instructions Chapter 38—Form HCFA-1984-99 (HCFA Pub. 15-2-38) (Superintendent of Documents No. HE 22.8/4) 2 • Hospice Cost Report Medicare Program Integrity Manual (HCFA Pub. 83) 2 • Medical Review of Partial Hospitalization Claims Medicare/Medicaid Sanction—Reinstatement Report (HCFA Pub. 69) 00-07 • Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded Reinstated—June 2000 00-08 • Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—July 2000 00-09 • Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—August 2000 October through December 2000 Intermediary Manual Part 3—Claims Process (HCFA Pub. 13-3) (Superintendent of Documents No. HE 22.8/6) 1811 • Extracorporeal Immunoadsorption Using Protein A Columns Hospital Outpatient Partial Hospitalization Services 1812 • Dialysis for End-Stage Renal Disease—General 1813 • Provider Electronic Billing File and Record Formats 1814 • Claims Processing Timeliness Beneficiary-Driven Demand Billing Under Home Health Prospective Payment System Prospective Payment System Pricer Program Home Health Agency Bills Denials and Conditional Payments in Medicare Secondary Payer Situations Provider Specific Payment Data Provider Specific Payment Data Record Layout and Description Intermediary Responsibilities The Cancel Only Adjustment Code (Action Code 4) 1815 • Payment for Blood Clotting Factor Administered to Hemophilia Inpatients 1816 • Bill Review for Partial Hospitalization Services Provided In Community Mental Health Centers Hospital Outpatient Partial Hospitalization Services 1817 • Heart Transplants 1818 • Oral Anti-Nausea Drugs as Full Therapeutic Replacements for Intravenous Dosage Forms As Part of a Cancer Chemotherapeutic Regimen 1819 • Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines 1820 • Review of Form HCFA-1450 for Inpatient and Outpatient Bills 1821 • Beneficiary-Driven Demand Billing Under Home Health Prospective Payment System Carriers Manual Part 3—Claims Process (HCFA Pub. 14-3) (Superintendent of Documents No. HE 22.8/7) 1679 • Extracorporeal Immunoadsorption Using Protein A Columns Coverage Summary Coding and Payment Denial Messages 1680 • Beneficiaries Previously Enrolled in Managed Care Who Return to Traditional Fee For Service 1681 • Type of Service 1682 • Furnishing Medicare Physician Fee Schedule Database Pricing Files Furnishing Physician Fee Schedule Data for Local and Carrier Price Codes Furnishing Physician Fee Schedule Data for National Codes Furnishing Fee Schedule (Excluding Physician Fee Schedule), Prevailing Charge and Conversion Factor Data to Palmetto GBA, Fiscal Intermediaries, State Agencies, Indian Health Services and United Mine Workers Health Maintenance Organization Processing Requirements Specialty Code/Place of Service 1683 • Durable Medical Equipment Regional Carrier Instructions for Denying Claims For Prescription Drugs Billed and/or Paid to Suppliers Not Licensed to Dispense Prescription Drugs 1684 • Responsibility to Download and Implement Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Fee Schedules 1685 • Home Use of Durable Medical Equipment Evidence of Medical Necessity Incurred Expenses for Durable Medical Equipment and Orthotic and Prosthetic Devices Evidence of Medical Necessity Oxygen Claims 1686 • Type of Service 1687 • End-Stage Renal Disease Bill Processing Procedures Home Dialysis Patients Options for Billing 1688 • Durable Medical Equipment Regional Carrier Instructions for Denying Claims for Prescription Drugs Billed and/or Paid to Suppliers Not Licensed to Dispense Prescription Drugs 1689 • Payment and Coding Requirements Processing Claims to Ensure That Payment Conditions Are Met Carriers Manual Part 4—Professional Relations (HCFA Pub. 14-4) (Superintendent of Documents No. HE 22.8/7-4) 23 • Registry Customer Information Control System Program Memorandum Intermediaries (HCFA Pub. 60A) (Superintendent of Documents No. HE 22.8/6-5) A-00-71 • Medical Review of Home Health Services—For Regional Home Health Intermediaries A-00-72 • Technical Correction to Coding Information for Hospital Outpatient Prospective Payment System A-00-73 • Clarification of Modifier Usage in Reporting Outpatient Hospital Services A-00-74 • October Outpatient Code Editor A-00-75 • Corrections to Calculation of Inpatient Payment Amounts A-00-76 • Clarification of the Application of the Regulations at 42 Code of Federal Regulations 413.134(l) to Mergers and Consolidations Involving Non-Profit Providers A-00-77 • Change in Hospice Payment Rates, Update to the Hospice Cap, Revised Hospice Wage Index and Hospice Pricer A-00-78 • Provider Statistical and Reimbursement Report A-00-79 • Settlement Agreement Between the Health Care Financing Administration and National Medical Care, Inc. d/b/a Fresenius Medical Care North America for Payment of Medicare End-Stage Renal Disease Bad Debts A-00-80 • Notification to Outpatient Hospital Service Providers Concerning Deductible and Coinsurance Amounts on Electronic Remittance Advice Version 3051.4a A-00-81 • Resolution of Outpatient Prospective Payment System Implementation Issues A-00-82 • January 2001 Update: Coding Information for Hospital Outpatient Prospective Payment System A-00-83 • Business Requirements for Processing Outpatient Encounter Data in the Health Care Financing Administration Data Center A-00-84 • Medicare+Choice Inpatient Encounter Data—Migration of Data Processing to the Health Care Financing Administration Data Center A-00-85 • The Report of Benefit Savings A-00-86 • Changes to Fiscal Year 2000 Nursing and Allied Health Education Payment Policies as Required by the Medicare, Medicaid, and State Child Health Insurance Program Balanced Budget Refinement Act of 1999, P. L. 106-113 A-00-87 • Off-Label Use of Oral Chemotherapy Drugs Methotrexate and Cyclophosphamide A-00-88 • Fee Schedule and Consolidated Billing for Skilled Nursing Facility Services A-00-89 • Implementation of Health Insurance Portability and Accountability Act Transaction Standards—Overview and Specific Instruction for Implementing the Inbound Claim A-00-90 • Policy Clarification: Coding for Adequacy of Hemodialysis A-00-91 • Inpatient Rehabilitation Facility Prospective Payment System A-00-92 • Corrections to Calculation of Federal Fiscal Year 2001 Inpatient Payment Amounts A-00-93 • Do Not Forward Initiative, Change Request 681, Transmittal No. AB-00-06, Dated February 2000 A-00-94 • New End Stage Renal Disease Composite Payment Rates Effective January 1, 2001 A-00-95 • Renewal of Program Memorandum A-97-8—Instructions to Implement the New Medicare Summary Notice Combined with Program Memorandum AB-98-31 A-00-96 • Clarification of C-Code Reportable Under the Hospital Outpatient Prospective Payment System A-00-97 • Partial Implementation of Change Request 1119 A-00-98 • Reporting of Outpatient Prospective Payment System and Home Health Prospective Payment System Data in Provider Remittance Advice Transactions A-00-99 • Medicare Contractor Use of the Regional Home Health Intermediary Outcomes and Assessment Information Set Verification Protocol for Review of Home Health Agency Prospective Payment Bills A-00-100 • Conversion to the UB-92 Version 6.0 and Continued Use of Version 5.0 A-00-101 • Medicare Outpatient Code Editor Version 16.1 A-00-102 • Hospital Outpatient Prospective Payment System Pass-Through Payment Corrections for Two Radiopharmaceuticals Program Memorandum Carriers (HCFA Pub. 60B) (Superintendent of Documents No. HE 22.8/6-5) B-00-50 • Home Health Prospective Payment System B-00-51 • Changes to Correct Coding Edits, Version 7.0, Effective January 1, 2001 B-00-52 • Schedule for Completing the Calendar Year 2001 Fee Schedule Updates and the Participating Physician Enrollment Procedures B-00-53 • Calendar Year 2001 Participation Enrollment and Medicare-Participating Physicians and Suppliers Directory Procedures B-00-54 • Program Integrity Management Reporting System B-00-55 • Durable Medical Equipment Regional Carrier Common Working File to Add ICD-9 Diagnosis Code for Oral Anti-Cancer Drugs B-00-56 • Durable Medical Equipment Regional Carrier Common Working File Edit# 5211 Services after the Date of Death for Durable Medial Equipment Rental Items B-00-57 • Part B Outbound X12N 837 Coordination of Benefits Mapping B-00-58 • Durable Medical Equipment Regional Carriers—Change in Common Working File for Code K0009 B-00-59 • Durable Medical Equipment Regional Carrier—Common Working File Revision for Oxygen Certificate of Medical Necessity B-00-60 • New Temporary “K” Codes for Augmentative and Alternative Communication Devices B-00-61 • Comprehensive Error Rate Testing Program Requirements for Medicare Contractor Operations B-00-62 • Promoting Influenza and Pneumococcal Vaccinations B-00-63 • Medicare Payment Allowance for Flu Vaccine B-00-64 • Program Integrity Sampling Module for Part B and Durable Medical Equipment Carriers B-00-65 • 2001 Physician Fee Schedule for Payment Policies B-00-66 • Durable Medical Equipment Regional Carrier Operating Instructions for Coverage of the Ultrasonic Osteogenic Stimulators for Fracture Healing: Effective for Services Performed on or after 1/1/2001 B-00-67 • Consolidated Billing for Skilled Nursing Facility Residents B-00-68 • X12N Professional Flat File B-00-69 • Blood Glucose Test Strips—Marketing to Medicare Beneficiaries B-00-70 • Changes to Correct Coding Edits, Version 7.1, Effective April 1, 2001 B-00-71 • Addition of a Miscellaneous “WW” Code and National Drug Code for Oral Anti-Cancer Drugs B-00-72 • Instructions to Implement the New Medicare Summary Notice—Program Memorandum B-98-4 and PM AB-98-31 B-00-73 • Correct Coding Initiative Edits Correction: Influenza (G0008), Pneumococcal (G0009), and Hepatitis B (G0010) Vaccine Codes B-00-74 • Claims Processing Instructions for Carriers To Make Available Claims and Medical Records for a Program Safeguard Contractor Task Order Request for Medical Record Review B-00-75 • Emergency Changes to the 2001 Medicare Physician Fee Schedule Database B-00-76 • Revised 2001 Anesthesia Conversion Factors Program Memorandum Intermediaries/Carriers (HCFA Pub. 60A/B) (Superintendent of Documents No. HE 22.8/6-5) AB-00-91 • Mammography Screening Payment Limit for Calendar Year 2001 AB-00-92 • Sending Common Working File Referrals for Initial Enrollment Questionnaire and Internal Revenue Services/Social Social Security Administration/Health Care Financing Administration Data Match Records to the Coordination of Benefits Contractor AB-00-93 • Coordination With the Y2K Program Safeguard Contractor AB-00-94 • Urokinase (Abbokinas) Shortage AB-00-95 • Facility Requirements for Transplantation Centers AB-00-96 • Clarification of Fiscal Intermediary and Durable Medical Equipment Regional Carrier Responsibilities Concerning Home Dialysis Method Election and Claims Processing AB-00-97 • Notification to Providers and Suppliers of Transaction and Code Set Rule Promulgated In Accordance With the Health Insurance Portability and Accountability Act AB-00-98 • Medicare Deductible and Premium Rates for Calendar Year 2001 AB-00-99 • Glucose Monitoring Note AB-00-100 • Mandatory Training on Ambulance Fee Schedule AB-00-101 • Notice of Interest Rate for Medicare Overpayments and Underpayments AB-00-102 • Clarification to Medicare Carriers Manual § 2130 Prosthetic Devices and Coverage Issues Manual § 60-9 Durable Medical Equipment Reference List—Coverage of Intermittent Catheterization AB-00-103 • Final Rule Revising and Updating Medicare Polices Concerning Ambulance Services AB-00-104 • Autologous Stem Cell Transplantation for Patients with Multiple Myeloma AB-00-105 • New Waived Test—November 9, 2000 AB-00-106 • Establishment of Provider/Supplier Information and Education Resource Directory AB-00-107 • Transfer of Initial Medicare Secondary Payer Development Activities to the Coordination of Benefits Contractor AB-00-108 • Glucose Monitoring AB-00-109 • 2001 Clinical Laboratory Fee Schedule an Laboratory Costs Subject to Reasonable Charge Payment Methodology AB-00-110 • Implementation of the New Payment Limit for Drugs and Biologicals AB-00-111 • Revised Claims Processing Instructions for Medicare Qualifying Clinical Trial Claims for Managed Care Enrollees AB-00-112 • Home Health Prospective Payment System/Consolidated Billing Edits and Systems Changes—Instructions for Standard Systems, Common Working File, and Contractors Part II AB-00-113 • Instructions for Implementing and Updating 2001 Payment Amounts for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies AB-00-114 • Update of Codes and Payments for Ambulatory Surgical Centers AB-00-115 • Source of Average Wholesale Price Data in Pricing Drugs and Biologicals Covered by the Medicare Program AB-00-116 • Local Medical Review Policy Development and Format AB-00-117 • Payment of Drugs, Biologicals and Supplies in a Comprehensive Outpatient Rehabilitation Facility AB-00-118 • Delay Implementation of the Ambulance Fee Schedule AB-00-119 • Change in the Collection of Comprehensive Encounter Data for the Medicare Choices Demonstration, Long-Term Care Demonstrations (Social Health Maintenance Organization Evercare, Department of Defense Subvention Demonstration, and Dual Eligible Demonstrations AB-00-120 • Operating Instructions for Coverage of Non-Implantable Pelvic Floor Electrical Stimulators AB-00-121 • Medicare Intermediary Claims Processing Standard Systems Delay of Calendar Year 2001 Quarter Release AB-00-122 • Appeals of Medicare Part A/Part B Coverage Determinations AB-00-123 • Use of Beneficiary Question & Answers on www.hcfa.gov AB-00-124 • Payment for Method II Home Dialysis Supplies AB-00-125 • Accelerated Referral of Non-Medicare Secondary Payor Delinquent Debts (Active and Currently Not Collectible to Debt Collection Center for Cross Servicing and Treasury Offset Program) AB-00-126 • Use of the American Medical Associations' Physicians' Current Procedural Terminology, Fourth Edition Codes on Contractors' Web Sites AB-00-127 • Reimbursement for Ambulance Services to Nonhospital-Based Dialysis Facilities AB-00-128 • Extension of the Limitation on Payment for Services to Individuals Entitled to Benefits on the Basis of End-Stage Renal Disease Who Are Covered by Group Health Plan AB-00-129 • Coordination of Benefits Contractor Fact Sheet for Providers AB-00-130 • Intestinal Transplantation AB-00-131 • Clarification to Implementation of the Ambulance Fee Schedule AB-00-132 • Clarification Regarding Release of Medicare Eligibility Data AB-00-133 • Coordination With Provider Education Program Safeguard Contractor AB-00-134 • Cervical or Vaginal Smear Tests (Pap Smears) in Calendar Year 2001 Clinical Diagnostic Laboratory Fee Schedule Program Memorandum State Survey Agencies (HCFA Pub. 65) (Superintendent of Documents No. HE 22.8/6-5) 99-2 • Guidelines and Exhibits Regarding Regulatory Requirements for Comprehensive Assessment and Use of the Outcome and Assessment Information Set State Operations Manual Provider Certification (HCFA Pub. 7) (Superintendent of Documents No. HE 22.8/12) 21 • List of Appendices Interpretive Guidelines and Survey Procedures—Hospital—Table of Contents Interpretive Guidelines for Home Health Agencies 22 • Minimum Data Set System System Description Administration Requirements Validation and Editing Process Correction of Errors in Minimum Data Set Records That Have Been Accepted by the Standard Minimum Data Set System at the State 23 • Hospice—Citations and Description Community Mental Health Centers—Citations and Description Attestation Statement Provider Agreement Fiscal Intermediary Medicare Provider Billing Number Deactivation Letter Used by Fiscal Intermediary Model Denial Letter for Community Mental Health Center Applicants—State Restrictions on Screening Model Letter, Notice of Findings of Non-Compliance Model Letter, Notice of Termination of Provider Agreement Model Letter, Community Mental Health Center That Has Ceased Operating Model Letter, Participation in Medicare as a Community Mental Health Center Providing Partial Hospitalization Services (Including Threshold and Service Requirements) Model Letter, Notice of Failure to Meet Threshold and Service Requirements Peer Review Organization Manual (HCFA Pub. 19) (Superintendent of Documents No. HE 22.8/8-15) 83 • Introduction Review Responsibilities to Handle Clinical Data Abstraction Center Referrals Developing the Capacity to Estimate Local Payment Error Rates Determining the Types of Errors and Developing the Interventions Necessary to Reduce or Eliminate Errors Developing, Applying, and Assessing the Effect of Interventions Collaborating With Provider and Practitioner Groups Collaborating Efforts with Federal and State Agencies and Other Medicare Contractors 84 • Review Process Notice of Disclosure Final Response to Complainants Disclosure of Quality Review Information to Complainants Request for Information Model Form Final Response to Inquirer Model Notice (Concern Involved Practitioner) Final Response to Inquirer Model Notice (Concern Involved Provider Facility) Hospital Manual (HCFA Pub. 10) (Superintendent of Documents No. HE 22.8/2) 762 • Extracorporeal Immunoadsorption Using Protein A Columns 763 • Billing for Sodium Ferric Gluconate Complex in Sucrose Injection 764 • Payment for Blood Clotting Factor Administered to Hemophilia Inpatients 765 • Billing for Hospital Outpatient Partial Hospitalization Services 766 • Heart Transplants 767 • Completion of Form HCFA-1450 for Inpatient and/or Outpatient Billing Renal Dialysis Facility Manual (Non-Hospital Operated) (HCFA Pub. 29) (Superintendent of Documents No. 22.8/13) 91 • Billing for Sodium Ferric Gluconate Complex in Sucrose Injection ESRD Network Organizations Manual (HCFA Pub. 81) (Superintendent of Documents No. HE 22.9/4) 12 • List of Commonly Used Acronyms, and Glossary Authority Purpose of End-Stage Renal Disease Network Organizations Requirements for End-Stage Renal Disease Network Organization Responsibilities of End-Stage Renal Disease Network Organizations Goals Network Organization's Role in Health Care Quality Improvement Program Annual Report Format Quarterly Progress and Status Report Format Outpatient Physical Therapy and Comprehensive Outpatient Rehabilitation Facility Manual (HCFA Pub. 9) (Superintendent of Documents No. HE 22.8/9) 15 • Billing Instructions for Partial Hospitalization Services Provided in Community Mental Health Centers Coverage Issues Manual (HCFA Pub. 6) (Superintendent of Documents No. HE 22.8/14) 127 • Extracorporeal Immunoadsorption Using Protein A Columns 128 • Air-Fluidized Beds 129 • Hyperbaric Oxygen Therapy 130 • Intravenous Iron Therapy 131 • Osteogenic Stimulation 132 • Durable Medical Equipment Reference List Speech Generating Devices 133 • Non-Implantable Pelvic Floor Electrical Stimulator 134 • Artificial Hearts and Related Devices Provider Reimbursement Manual—Part 1 (HCFA Pub. 15-1) (Superintendent of Documents No. HE 22.8/4) 418 • Requirements for Distinct Part Certification 419 • Regional Medicare Swing-Bed Skilled Nursing Facility Rates Provider Reimbursement Manual—Part 2 Provider Cost Reporting Forms and Instructions Chapter 35—Form HCFA-2540-96 (HCFA Pub. 15-2-35) (Superintendent of Documents No. HE 22.8/4) 9 • Skilled Nursing Facility, and Skilled Nursing Facility Health Care Complex Cost Report, Form HCFA-2540-96 Provider Reimbursement Manual—Part 2 Provider Cost Reporting Forms and Instructions Chapter 36—Form HCFA-2552-96 (HCFA Pub. 15-2-36) (Superintendent of Documents No. HE 22.8/4) 7 • Hospital and Hospital Health Care Complex Cost Report, Form HCFA-2552-96 Medicare Program Integrity Manual (HCFA Pub. 83) (Superintendent of Documents No. HE 22) 3 • Types of Claims For Which Contractors Are Responsible The Medicare Medical Review Program National Coverage Policy and Local Medical Review Policy and Individual Claim Determinations Individual Claim Determinations Identification of Services for Which A Local Medical Review Policy is Needed Coding Rules in Local Medical Review Policy Local Medical Review Policy Notice Process Manual Review Personnel and Levels of Review The Contractor Advisory Committee Medicare Fraud Information Specialist Medicare Integrity Program—Provider Education and Training Activities Contractor Medical Director Office of Inspector General Referrals and Appropriate Fraud Information Database Entries Introduction Provider Tracking System Evaluating Effectiveness of Corrective Actions Verifying Potential Errors and Setting Priorities Determining Whether the Problem is Widespread or Provider-Specific Provider Education Prepayment Review of Selected Claims Automated and Manual Prepayment Review Prepayment Edits Development of Claims for Additional Documentation Location of Postpay Reviews Advance Determination of Medicare Coverage of Customized Durable Medical Equipment Effectuating Favorable Final Appellate Decisions That A Beneficiary is “Confined to Home” Contractor Advisory Committee Structure Contractor Advisory Committee Process The Medicare Fraud Program Staffing of the Fraud Unit and Security Training Durable Medical Equipment Fraud Functions Identifying Potential Errors—Introduction Data Analysis Resources Needed for Data Analysis Determine Indicators to Identify Norms and Deviations Overview of Prepayment and Postpayment Review Automated and Manual Prepayment Review Categories of Medical Review Edits Overpayment Assessment Procedures Consent Settlement Offer Based on Potential Projected Overpayment Certified Medical Necessity as the Written Order Pick-up Slips Incurred Expenses for Durable Medical Equipment and Orthotics and Prosthetic Devices List of Medical Review Codes, Categories, and Conversion Factors for Fiscal Year 2000 Description of Carrier Advisory Committee Consent of Settlement Documents HCFA Forms 700 and 701 Medicare/Medicaid Sanction—Reinstatement Report (HCFA Pub. 69) 00-10 • Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded Reinstated—September 2000 00-11 • Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—October 2000 00-12 • Report of Physicians/Practitioners, Providers and/or Other Health Care Suppliers Excluded/Reinstated—November 2000 January 2001 through March 2001 Intermediary Manual Part 1—Claims Process (HCFA Pub. 13-1) (Superintendent of Documents No. HE 22.8/6-3) 130 • Principles of Reimbursement for Administrative Costs Intermediary Manual Part 2—Claims Process (HCFA Pub. 13-2) (Superintendent of Documents No. HE 22.8/6-3) 415 • System Security Authority, Exhibits, and Appendices: www.hcfa.gov/pubforms/pim/pimtoc.htm 416 • Recovery of Overpayments Due to a Pattern of Furnishing Excessive or Noncovered Services 417 • This Transmittal contains no updated information Intermediary Manual Part 3—Claims Process (HCFA Pub. 13-3) (Superintendent of Documents No. HE 22.8/6) 1822 • No Legal Obligation To Pay For Or Provide Services Review of Form HCFA-1450 For Inpatient And Outpatient Bills Medicare Secondary Payor Maintenance Transaction Record Processing Alphabetic Listing Of Data Elements 1823 • Screening Pap Smears and Screening Pelvic Examinations 1824 • Colorectal Screening 1825 • Hospital Outpatient Partial Hospitalization Services 1826 • Review of Form HCFA-1450 For Inpatient and Outpatients Bills 1827 • Beneficiary-Driven Demand Billing Under Home Health Prospective Payment System Carriers Manual Part 2—Program Administration (HCFA Pub. 14-1) (Superintendent of Documents No. HE 22.8/7-2) 124 • Principles of Reimbursement for Administrative Costs Budget Preparation Budget Preparation Carriers Manual Part 3—Program Administration (HCFA Pub. 14-2) (Superintendent of Documents No. HE 22.8/7) 142 • System Security Authority, Exhibits, and Appendices: www.hcfa.govpubforms/83_pim/pimtoc.htm Carriers Manual Part 3—Program Administration (HCFA Pub. 14-3) (Superintendent of Documents No. HE 22.8/7) 1690 • Claims for Anesthesia Services Performed on and After January 1, 1992 Entities/Suppliers Whose Physicians' Services Are Paid for Under Fee Schedule Method for Computing Fee Schedule Amounts Payment Conditions for Anesthesiology Services Assisted Suicide Site-of-Service Payment Differential Optometry Services Allowable Adjustments Evaluation and Management Service Codes—General Payment for Office/Outpatient Visits Consultations Payment For Physician's Visits To Residents of Skilled Nursing Facilities and Nursing Facilities Home Care and Domiciliary Care Visits Prolonged Services Home Services Geographic Practice Cost Indices by Medicare Carrier and Locality Determining Reasonable Charges for Services of Nurse Practitioners and Clinical Nurse Specialists 1691 • No Legal Obligation To Pay For Or Provide Services Medicare Secondary Payer General Provisions Medicare Secondary Payer General Provisions Applicable To Individuals Covered By Group Health Plans and Large Group Health Plans Limitation On Payment For Services To Individuals Eligible For Or Entitled To Benefits On Basis Of End Stage Renal Disease Who Are Covered By Group Health Plans 1692 • Patient and Insured Information Physician or Supplier Information Place of Service Codes and Definitions Exhibits 1693 • Physicians Billing for Purchased Diagnostic Tests (Other Than Clinical Diagnostic Laboratory Tests 1694 • Screening Pap Smear Coverage and Payment Requirements Screening Pelvic Examination Coverage and Payment Requirements Diagnosis Coding Billing Requirements Calculating Frequency Limitations Common Working File Edits Medicare Summary Notices and Explanations of Your Part B Medicare Benefits Remittance Advice Notices 1695 • Coding Changes Became Effective for Hepatitis B Vaccines Through the Health Care Financing Administration Common Procedure Coding System Annual Updates 1696 • Evidence of Medical Necessity Oxygen Claims 1697 • Covered Services and Health Care Financing Administration Common Procedure Coding System Codes Coverage Criteria Determining Whether or Not the Beneficiary is at High Risk for Developing Colorectal Cancer Determining Frequency Standards Noncovered Services Payment Requirements Common Working File Edits Medicare Summary Notices and Explanations of Your Part B Medicare Benefits Remittance Advice Notices Ambulatory Surgical Center Facility Fee 1698 • Dual Eligibility/Entitlement Situations Program Memorandum Intermediaries (HCFA Pub. 60A) (Superintendent of Documents No. HE 22.8/6-5) A-01-01 • January Outpatient Code Editor Specifications Version (V2.0) A-01-02 • Use of Telehealth In Delivery of Home Health Services A-01-03 • Temporary 2-Month Extension of Periodic Interim Payment for Home Health Providers A-01-04 • Change in Hospice Payment Rates As Required by the Benefits Improvement and Protection Act A-01-05 • Advance Beneficiary Notices Must Be Given To Beneficiaries and Demands Bills Must Be Submitted By Home Health Agencies A-01-06 • Restoration of Full Home Health Market Basket Update for Home Health Services for Fiscal Year 2001 and Temporary 10 Percent Payment Increase for Home Health Services Furnished in a Rural Area For 24 Months Under the Home Health Prospective Payment System A-01-07 • Application of Wage Index for Wichita, Kansas, Metropolitan Statistical Area Hospice Providers A-01-08 • Adjustments to the Federal Skilled Nursing Facility Prospective Payment System Rates for Fiscal Year 2001 A-01-09 • Exemption of Critical Access Hospital Swing Beds From Skilled Nursing Facility Prospective Payment System A-01-10 • Technical Corrections to the January 2001 Update: Coding Information for Hospital Outpatient Prospective Payment System A-01-11 • Changes to Federal Fiscal Year 2001 Inpatient Hospital Payment As Required By the Benefits Improvement And Protection Act of 2000 (Public Law 106-554) A-01-12 • Provider Statistical and Reimbursement Report A-01-13 • Clarification of Allowable Medicaid Days in the Medicare Disproportionate Share Hospital Adjustment Calculation A-01-14 • Clarifications to Transmittal A-01-03, Change Request 1437, Temporary 2-Month Extension of Periodic Interim Payment for Home Health Providers A-01-15 • Implementation of Sections 111, 401, 403, and 405 of the Medicare, Medicaid, and State Child Health Insurance Program Benefits Improvement and Protection Act of 2000 A-01-16 • Claims Guidance Related to Outpatient Code Editor Edit 27 A-01-17 • Impact of the Benefits Improvement and Protection Act on Devices Eligible for Transitional Pass-Through Payments Under the Hospital Outpatient Prospective Payment System A-01-18 • Effective Dates for all Medicare Secondary Payer Sub-Modules Found in the Medicare Secondary Payer Pay Module A-01-19 • New Composite Payment Rates Effective April 1, 2001, through December 31, 2001, and the Application of Exceptions Under the End Stage Renal Disease Composite Rate System A-01-20 • Health Insurance Portability and Accountability Act Health Care Claim and Coordination of Benefits A-01-21 • Clarification of the Homebound Definition Under the Medicare Home Health Benefit A-01-22 • Extension of Due Date for Filing Provider Cost Reports A-01-23 • Modification to Home Health Prospective Payment System Date Matching Edit in Medicare Standard System Software A-01-24 • Further Guidance on Handling Outpatient Code Editor Error 13 A-01-25 • New Processing and Reporting Requirements for Resolution of Outpatient Prospective Payment System Implementation Issues A-01-26 • Clarification of Exclusions to the Temporary 2-Month Extension of Periodic Interim Payments For Home Health Providers A-01-27 • Problems with Processing of Non-Outpatient Prospective Payment System Claims Through the Outpatient Code Editor A-01-28 • Addendum to Periodic Interim Payments For Home Health Providers A-01-29 • Medicare Review of Certification and Re-Certifications of Residents in Skilled Nursing Facilities A-01-30 • Advance Beneficiary Notices Must Be Given To Beneficiaries and Demand Bills Must Be Submitted By Home Health Agencies A-01-31 • Clinical Diagnostic Laboratory Tests Furnished by Critical Access Hospitals A-01-32 • Biweekly Interim Payments for Certain Hospital Outpatient Items and Services That Are Paid On A Cost Basis, and Direct Medical Education Payment, Not Included in the Hospital Outpatient Prospective Payment System A-01-33 • Fiscal Intermediary Community Mental Health Center Enrollment and Change of Ownership Site Visit Process and Coordination With National Community Mental Health Center Site Visit Contractor A-01-34 • Salary Equivalency Guidelines Update Factors A-01-35 • Medicare+Choice Inpatient Encounter Data-Migration of Data Processing to the Health Care Financing Administration Data Center A-01-36 • April Outpatient Code Editor Specifications Version (V2.1) A-01-37 • Change in the Standard Paper Remittance Advice for Home Health Agencies A-01-38 • Changes to Fiscal Year 2001 and Fiscal Year 2002 Graduate Medical Education Policies as Required by the Medicare, Medicaid, and State Child Health Insurance Program Balanced Budget Refinement Act of 1999, P.L. 106-113, and the Medicare, Medicaid, and State Child Health Insurance Program Benefits Improvement and Protection Act of 2000, P.L. 106-554 A-01-39 • Postacute Care Transfer Policy A-01-40 • Additional Information on Transitional Pass-Through Devices and Drugs A-01-41 • Categories for Use in Coding Devices Eligible for Transitional Pass-Through Payments Under the Hospital Outpatient Prospective Payment System A-01-42 • Indian Health Service Hospital Payment Rates for Calendar Years 2000 and 2001 A-01-43 • This Transmittal Has Been Rescinded A-01-44 • Standard Systems Changes Required to Incorporate Provider-Specific Payment-to-Cost Ratios into the Calculation of Interim Transitional Corridor Payment Outpatient Prospective Payment System A-01-45 • Clarification and HCFA Common Procedure Coding System Coding Update: Part B Fee Schedule and Consolidated Billing for Skilled Nursing Facility Services A-01-46 • Further Guidance on Handling the Outpatient Code Editor Edit 43 A-01-47 • Implementation of Updates to the Federal Fiscal Year 2001 Inpatient Hospital Payments and Disproportionate Share Hospital Thresholds and Adjustments as Required by the Benefits Improvement and Protection Act of 2000 (Public Law 106-554) Program Memorandum Carriers (HCFA Pub. 60B) (Superintendent of Documents No. HE 22.8/6-5) B-01-01 • Use of Statistical Sampling for Overpayment Estimation When Performing Administrative Reviews of Part B Claims B-01-02 • Medicare Requirements for Payment for Medicare-Covered Drugs Administrative Reviews of Part B Claims B-01-03 • Request for Carriers to Include a Message on Paper Remittance Notices B-01-04 • New Temporary “K” Codes for Insulin Lispro B-01-05 • Matrix to Complete Provider/Supplier Enrollment Application (HCFA-855) B-01-06 • Health Insurance Portability and Accountability Act Health Care Claim and Coordination of Benefits B-01-07 • Apligraf (Graftskin) B-01-08 • Change in Effective Data For Five “WW” Codes For Methotrexate B-01-09 • Suspension of Recently Implemented Correct Coding Initiative Edits Bundling Evaluation and Management Codes and Ophthalmologic Codes Revision to Version 7.0 B-01-10 • Systems Requirements for the Benefits Improvement and Protection Act of 2000 for Drugs and Biologicals Covered by Medicare, Section 114, Mandatory Submission of Assigned Claims for Drugs and Biologicals B-01-11 • Supplier Billing for Glucose Test Strips B-01-12 • Initial Viable Information Processing Systems Virtual Multiple Storage Changes Necessary to Allow for “Full Program Safeguard Contractor Implementation” B-01-13 • Explanation of Medicare Benefits, Medicare Summary Notice and Supplier Remittance Message Durable Medical Equipment Regional Carriers Must Use on Claims for Drugs and Related Equipment Supplied by a Supplier Not Licensed to Dispense the Drug B-01-14 • New Oral Anti-Cancer Drugs Approved for Use by Medicare B-01-15 • Durable Medical Equipment Regional Carrier System Requirements to Implement § 114 of the Benefits Improvement and Protection Act of 2000 B-01-16 • Clarification of Medicare Policies Concerning Ambulance Services B-01-17 • Durable Medical Equipment Regional Carrier System Changes to Enforce Medicare Requirements for Payment for Medicare-Covered Drugs B-01-18 • Changes to Correct Coding Edits, Version 7.2, Effective July 1, 2001 B-01-19 • Additional Information for Trail Blazer Health Enterprise for Centralized Billing of Flu and Pneumococcal Vaccinations B-01-20 • Two New “K” Codes for Heavy Duty Hospital Beds B-01-21 • Durable Medical Equipment Regional Carrier System Requirements to Implement § 114 of Benefits Improvement and Protection Act of 2000 (Additional Requirements for Change Request (CR) 1562, Transmittal B-01-15) B-01-22 • Initial Viable Information Processing System Medicare System Virtual Multiple Storage Changes Necessary to Allow for Full Program Safeguard Contractor Implementation Program Memorandum Intermediaries/Carriers (HCFA Pub. 60A/B) (Superintendent of Documents No. HE 22.8/6-5) AB-01-01 • Upcoming Train the Trainer Sessions on Skilled Nursing Facility Prospective Payment System and Consolidated Billing Updates AB-01-02 • Managing Medicare Appeals Workloads in Fiscal Year 2001 AB-01-03 • April Quarterly Update for 2001 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Fee Schedule AB-01-04 • Implementation of the National Drug Code to Process Claims for Prescription Drugs and Biologicals and Request for Comments AB-01-05 • New Waived Tests—Effective Date of Receipt AB-01-06 • Replacement of Prosthetic Devices and Par [Text truncated at 120,000 characters. The full text is on the page linked above.] --- Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/fr%3A02-16147. Public record. Not legal advice.